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Full text of "Practical home nursing : an elementary condensed textbook for trained attendants"

WY 195 H496p 1919 
54730880R 




NATIONAL LIBRARY OF MEDICINE 



SURGEON GENERAL'S OFFICE 

LIBRARY. 

ANNSX 



Section 



no. 113, No. -c2-djl-aLL4 

W. D. S. G. O. / 5-613 



PRACTICAL HOME NURSING 



THE M ACM ILL AN COMPANY 

NEW YORK • BOSTON • CHICAGO - DALLAS 
ATLANTA • SAN FRANCISCO 

MACMILLAN & CO., Limited 

LONDON • BOMBAY • CALCUTTA 
MELBOURNE 

THE MACMILLAN CO. OF CANADA, Ltd. 

TORONTO 



PRACTICAL 
HOME NURSING 



AN ELEMENTARY CONDENSED TEXT- 
BOOK FOR TRAINED ATTENDANTS 



BY 

LOUISE HENDERSON, R.N. 

Director of Trained Attendant Classes, Ballard School, 
Central Branch Y. W. C. A. of New York 




THE MACMILLAN COMPANY 
1919 

All rights reserved 



'A 5 
HIS 



COPYEIGHT, 1919 

By THE MACMILLAN COMPANY 
Set up and electrotyped. Published January, 1919. 



©C!.Ar>!2l28t* 



jan 22 1919 



PEE FACE 



During a period of some years in teaching classes for 
Trained Attendants the need has been felt for a simple 
textbook. This little book, therefore, is based on the requi- 
site knowledge for such courses and covers only just 
enough anatomy and physiology to make clear the reasons 
for the practical work involved. 

Care has been taken to define clearly and accurately the 
different steps in the necessary technique of simple treat- 
ments and the care and comfort of the patient. The 
treatment in cases of common emergencies has been out- 
lined ; the subject of acute disease and the treatment pecul- 
iar to such conditions has purposely not been discussed. 



L. H. 



CONTENTS 



CHAPTER I 



PAGE 



Structure of the Body 



1 



Origin. Skeleton. Bones. Cavities. Organs. Skin. 
Membranes. Nervous System. 



Composition of Blood. Preparations for Blood Tests. 
Structure and Function of Heart and Blood Vessels. 
Circulation of the Blood. Lymphatics. Structure and 
Function of the Lungs. Method of Counting Respira- 
tion and Pulse. Variations in Body Temperature and 
Methods of Taking It. 



The Urinary Tract 

Structure and Function of the Kidneys. Bladder. 
Composition and Normal Amount of Urine. Securing 
Specimens. 

CHAPTER IV 

The Digestive Tract 

Functions of Digestive Organs. Process of Diges- 
tion. Food Elements. Diet. Serving Food. Ar- 
ranging Tray. Feeding Patient. 



CHAPTER II 



Circulation of the Blood 



9 



CHAPTER III 



CHAPTER V 



Recipes 



35 



CONTENTS 

CHAPTER VI page 

Ventilation 44 

Constituents of Air. Causes of Impurities. Neces- 
sity of Ventilation. Methods of Ventilating a Sick 
Room. 

CHAPTER VII 

Bacteria 49 

Origin. Bacteria in Disease and in Wounds. Im- 
portance of Preventive Measures. Sterilization. Prac- 
tical Methods for Disinfecting Discharges. Common 
Disinfectants. 

CHAPTER VIII 

Model Sick Room 60 

Ideal Room. Furnishings. Care of Room. Meth- 
ods of Cleaning. Bed and Bedding. Making Bed and 
Changing Bedding. Arranging Pillows. Use of 
Sickroom Appliances. 

CHAPTER IX 

Moving and Lifting 74 

Practical Methods of Moving Patients Comfortably. 

CHAPTER X 

Baths 79 

Structure and Function of the Skin. Importance of 
Bathing. Methods of Giving Different Kinds of 
Baths. Personal Care of Patient. 

CHAPTER X. 

Bed Sores 93 

Causes of Pressure Sores. Practical Methods of 
Preventing Their Development. 

CHAPTER XII 

Enemata 96 

Methods of Giving Different Kinds of Enema. Irri- 
gations and Douches. 



CONTENTS 

CHAPTEK XIII page 

External Applications 106 

Dry and Moist Heat. Poultices. Stupes. Counter 
Irritants. Ice Bags. Compresses. 

CHAPTER XIV 
Medicines 116 

Important Rules to be Observed in tbe Care and 
Giving of Medicines. Table of Measures. 

CHAPTER XV 

Symptoms 123 

General Observation of Symptoms. Relation of One 



Symptom to Another. Methods of Keeping a Written 
Record. 

CHAPTER XVI 

Special Care in Conditions of the Female Generative 

Organs 129 

Structure and Function of Female Generative Or- 
gans. Positions for Examination. Dorsal. Sims. 
Knee and Chest. 

CHAPTER XVII 

Minor Illnesses and Disorders 133 

Symptoms and General Treatment in Relation to the 
More Common Disorders. 

CHAPTER XVIII 
Emergencies and First Aid Treatment 140 

Methods of First Aid Treatment Applied to Common 
Emergencies. Fainting — Fractures — Hemorrhages 
— Poisoning, Etc. 



CONTENTS 



CHAPTEE XIX 



PAGE 



Bandages 161 

Kinds. Materials Used. Principles of Applying 
Bandages in General and for Special Purposes. 

CHAPTER XX 

Entertainment of Patient 180 

Suggestions as to Common Sense Methods of En- 
tertaining Convalescents. Suitable Occupations for 
Adults and Children. 

CHAPTER XXI 

The Care of Children 186 

The Needs of Children. Special Care of Newly 
Born Infants. General Care of Small Children — 
Nursery — Methods of Bathing. Forming Habits. 
General Principles of Infant Feeding — Process of 
Modifying Milk — Formulas. 



Special Consideration of the Needs of Sick Chil- 
dren. Diet. Methods of Restraining. Symptoms and 
Treatment of the More Common Illnesses. Care in 
Convalescence. 



CHAPTER XXII 



Care of Sick Children 



198 



CHAPTER XXIII 



Don'ts 



208 



Suggestions for Thought in the Nursing of the Sick. 



LIST OF PLATES 

FACING 
PAGE 

Patient drinking through glass feeding tube 28 

A comfortable arrangement of pillows. Upper bed clothes 

folded back 66 

Patient sitting up, reading in bed 72 

Attendants in position to move patient up in bed ... 74 

Drawing patient up from pillow 76 

Foot bath in bed. Blanket turned back to show tub ... 86 

Applying hot or cold compresses to the eye 114 

Sling for arm 

Roller bandage for broken collar-bonej 
Roller bandage to cover one eye] 



164 



174 



176 



Roller bandage for the ear 
Recurrent bandage for the scalp ") 
Roller bandage for sprained anklej 

Method of restraining the arms 196 

Method of restraint 198 



LIST OF DIAGRAMS 



PAGE 

The Human Skeleton 2 

Lungs and Air Passages 11 

Alimentary Canal 22 

Triangular Bandage 161 

Four-tailed Bandage 162 

Triangular Bandage Folded 164 

Spiral Bandage 165 

Spiral Keverse Bandage 165 

Figure of Eight Bandage 165 



PRACTICAL HOME NURSING 



CHAPTER I 

THE STEUCTUEE OF THE BODY 

The Nervous System 

Origin of the body. Life originates from one cell. 
This divides into two, each successive cell subdividing 
until numerous ones are formed. Cells of a like kind 
unite to make tissue. Tissues of a similar kind unite and 
form larger units, such as muscular tissue, blood tissue 
and fluids which in turn combine to form organs, muscle 
and bone. 

BONES 

The skeleton serves as the foundation of the body and 
gives it form. It is also a means of attachment for the 
soft parts, and acts as a protection to the vital organs. It 
consists of 206 distinct bones which are held together at 
the joints by ligaments. 

The bone substance is composed of animal matter which 
is hardened by being mixed with salts, principally salts of 
lime. In children, the bones are softer than in older 
people because they contain less earthy salts and more 
animal matter. Therefore the older the person the more 
brittle the bones become and the more liable to break. 

Enveloping the bone is the membrane called the peri- 
osteum which protects and nourishes it and is very sensi- 
tive when injured. 




The Human Skeleton 



THE STRUCTURE OF THE BODY 3 



TABLE OF BONES 

Cranium or Head 8 

Face 14 

Ears 6 

Hyoid — supporting tongue 1 

Trunk of Body 

Sternum or chest bone 1 

Ribs 24 

Vertebrae or backbone 26 

Upper Extremity 

Clavicle or collar bone 1 

Scapula or shoulder blade 1 

Humerus or arm 1 

££" } F ™ ::::::::: ! 

Carpus or wrist bones 8 

Metacarpus or hand bones ... 5 
Phalanges or finger bones ... 14 

32 x 2 = 64 

Lower Extremity 

Hip bone 1 

Femur or thigh-bone 1 

Patella or knee-cap 1 

Tibia 1 L 1 

Fibula J 1 

Tarsus — ankle 7 

Metatarsus — foot 5 

Phalanges or toe bones 14 

32x2 = 62 

Four varieties of bone comprise the human skeleton: 
Long : — serve to support the weight and act as levers : 
Example : — legs, arms. 



4 PRACTICAL HOME NURSING 



Flat : — for protection and to provide a broad surface for 
muscular attachment. 
Example : — Ribs and sternum. 
Short : — for strength and compactness. 

Example : — wrist and ankle. 
Irregular: — lack definite shape and so are not to be clas- 
sified with the others. 
Example : — vertebrae. 

CAVITIES AND ORGANS 

Cranial Brain 

Spinal canal Spinal cord 

Thoracic or chest . . . Lungs, Heart, Trachea, Aesoph- 
agus. 

The Diaphragm muscle separates the thoracic ab- 
dominal cavities. 

* Abdominal Stomach, Liver, Pancreas, Small 

and Large Intestines, Spleen, 
Kidneys, Appendix 

Pelvic Some of the Generative Organs, 

Bladder and Rectum. 

There are also small cavities such as the mouth, nose, eye, 
ear. 

Note: Position of organs in the abdominal cavity. 

The stomach is situated in the upper part, to the center 
and left. 

The liver is in the right hand upper part below the 
diaphragm. 

The spleen is in the upper, left-hand part below the 
diaphragm. 

The kidneys are at the small of the back on either side 
of the spine, about the waist line. 
The pancreas is behind the stomach. 
The small intestines are in the lower part of the cavity. 



THE STRUCTURE OF THE BODY 5 



The large intestines nearly surround the small intestines. 
The appendix is at the point where the small and large 
intestines meet on lower right hand side. 

GLANDS 

A gland is an organ which has the power to abstract 
from the blood certain materials and convert them into a 
new substance. 

JOINTS 

A joint is the point of union of two bones. The ends 
of the bone at all such points are covered with a smooth 
substance called cartilage, which helps them to glide easily 
one against the other, and at all joints the synovial fluid 
is secreted which lubricates them and allows movement 
without friction. The ends of the bones are held together 
by ligaments. 

LIGAMENTS 
Ligaments are strong bands of fibrous tissue attached 
to the bones on either side of a joint. They are tough and 
inelastic though, at the same time, very flexible thereby 
allowing motion of the joints while holding them closely 
in position. 

MUSCLES 

Muscular tissue commonly called the flesh of the body 
is composed of small fibers united in a sheath-covering, and 
bundles of these bound together form the different muscles. 
They hold the bones together and serve to give shape and 
power of motion to the body. Muscle has the power of 
shortening in length and increasing in thickness, and upon 
this all motion depends. 

When a muscle contracts, its two ends and whatever is 
fastened to these two ends, are brought together. In this 
way the bones of the body are made to move, and for every 
muscle that acts upon a limb from one direction, there is 
another muscle with a directly opposite action. 



6 



PRACTICAL HOME NURSING 



Examples of the uses of muscles are : 
Locomotiou Work 
Breathing Speech 
Facial expression Peristaltic action. 

There are two varieties of muscles : 

Voluntary, or those that can be made to act by the power 
of the will, and 

Involuntary, or those acting independently of the will 
and without one being conscious of them. 

The action of the voluntary muscles is made possible 
through the nerves as each muscle is in communication 
with the brain or spinal cord through a separate nerve 
fiber. 

TENDONS 

Tendons are small, glistening cords of fibrous tissue 
which attach muscle to bone. A cut tendon is always seri- 
ous because it deprives the attached muscle of its power 
to move the bone. 

CONNECTIVE TISSUE 
Connective tissue is a network of fibrous tissue with 
fat cells imbedded in it, and this surrounds the muscles 
and organs. 

THE SKIN 

The skin forms the outer covering and protection of the 
body. Its chief uses are : 

First — as a covering for the body. 

Second — as a heat regulator, by evaporation of per- 
spiration on the surface. 

Third — as a waste remover, through the sweat glands. 

Fourth — as a special organ for the sense of touch. 

It consists of an external layer called the epidermis or 
scarf skin and an internal layer called the derma or true 
skin. 



THE STRUCTURE OF THE BODY 7 



The derma consists of a fibrous substance in which are 
imbedded nerves, blood vessels, sweat glands and sebaceous 
or oil glands, while upon its surface are a number of small, 
highly sensitive projections. Each one of these has a tiny 
nerve which ends in it, and the sense of touch lies here. 

The sweat glands have the function of separating w T aste 
material from the blood in the form of perspiration, which 
passes from the glands to the surface by means of ducts 
and pores. 

The hair and nails are appendages of the skin. 

MUCOUS MEMBRANE 

At the edge of the openings leading into the body, the 
skin ends and is replaced with soft, reddish tissue, the 
mucous membrane, which forms a smooth lining for the 
interior of all bodily tracts. Its surface is lubricated by a 
secretion called mucus. This membrane is very absorb- 
ent and sensitive to infection. 

SEROUS MEMBRANE 

This is a thin tissue lining some of the cavities of the 
body and covering its organs, as for example : 

Around the lungs, where it is called the pleura, 
Around the intestines, where it is called the peritoneum, 
Around the heart, where it is called the pericardium. 
This membrane secretes a fluid to moisten its surfaces. 

THE NERVOUS SYSTEM 
The nervous system is a chain of nerve cells in close 
relation to each other and extending by branching nerve 
fibers to all parts of the body. 

The brain, which is enclosed in the skull, is the central 
power, and the spinal cord (protected by the strong bones 
of the vertebrae or backbone) acts in alliance with the 
brain, and from these centers all nerves branch. 

The nerves control the muscles and in case there is pres- 



8 



PRACTICAL HOME NURSING 



sure from any cause ou a nerve, the muscle controlled by 
it is weakened or paralyzed until the pressure is removed, 
after which it may regain its power by gradually increased 
exercise. 

The nervous and physical systems affect one another 
closely, so that in nursing the sick, special care should be 
taken not to overtire or over-excite the nervous system be- 
cause of its effect on the physical condition, nor to overtax 
the physical strength because of its effect upon the nerves. 

Reaction from nerve strain usually means physical ex- 
haustion and the best remedies are rest, quiet, sleep, and, 
if possible, diversion from the cause of the nerve strain. 

QUESTIONS 

What elements in food supply bone with nourishment ? 

Name bones of the upper extremity. 

Name bones of the lower extremity. 

Describe the clavicle. 

What bones form the pelvic cavity ? 

Where is the diaphragm and what is its function ? 

Describe the formation of a joint. 

What are the functions of muscles ? 

Name the organs of chest and abdominal cavities. 

Describe the skin. 

What is the central force of the nervous system ? 
What organs do the nerves most directly control ? 
How may nerve strain be prevented ? 



CHAPTEK II 



CIRCULATION OF THE BLOOD 

Respiration — Pulse — Temperature 

Blood. Blood, the vital fluid of the body, is composed 
of red and white corpuscles or little solid bodies floating in 
a serum. It is the medium for conveying both oxygen 
from the air and the product of food to the tissues of the 
body to give nourishment and to create heat and energy. 
This oxygen is derived from contact of the blood with air 
iu the lungs and the product of food (after the comple- 
tion of the process of digestion and absorption), is con- 
veyed directly into the blood circulation. Blood also 
has the power of collecting waste from the tissues and 
bringing it to the lungs to be breathed out from the body. 

Blood tests. Blood tests are made by a physician to 
determine the condition of the blood by analysis. One 
method is to prick either the ear or the tip of the finger 
and obtain blood in that way ; another is to have the blood 
drawn directly from a vein. In either case, the surface 
of the skin should be disinfected with alcohol, or painted 
over with iodine before the physician draws the blood 
from the part. 

Blood pressure. By blood pressure is meant the pres- 
sure exerted by the blood on the walls of the vessels in 
which it is flowing. 

CIRCULATION OF THE BLOOD 

Circulation is the conveying of the blood through the 
body by means of the heart and three kinds of blood vessels. 

The heart is a hollow muscular organ about five inches 
long, placed in the center and left of the chest cavity. The 



10 PRACTICAL HOME NURSING 



left side of the heart which always contains arterial or pure 
blood, is completely separated from the right side which 
contains venous or impure blood. Each side is divided 
into two parts ; an auricle and a ventricle, with a valve be- 
tween. The heart is provided with a covering called the 
pericardium. 

Arteries are the vessels which carry pure bright blood 
from the left side of the heart through the body. 

Veins are the vessels which bring the dark, impure 
blood back to the right side of the heart. They are pro- 
vided with valves which prevent mixing of the impure with 
the pure blood. 

Capillaries connect the arteries and veins. They are 
very minute and almost porous vessels and during the time 
the blood passes through them it gives off vitality and nour- 
ishment to the tissues and absorbs impurities from the 
tissues. 

Circulation is carried on as follows : the contraction of 
the heart forces the blood from the left side into the aorta, 
the largest artery in the body, and then to smaller and 
smaller arteries until it reaches the capillaries. After 
circulating there, it goes first into the small and then into 
the larger veins, until finally the two largest veins of the 
body, the superior and inferior vena cava, bring the 
blood to the right side of the heart. It is then carried to 
the lungs through the pulmonary artery, (this is the only 
artery that carries impure blood), to be purified by coming 
in contact with oxygen from the air, and by giving off im- 
purities to be breathed out. The pulmonary veins (the 
only veins that carry pure blood) take it back to the left 
side of the heart. 

THE LYMPHATIC SYSTEM 

The lymphatics are an extensive network of small ves- 
sels distributed generally through the body, and contain a 
fluid called lymph. They are often spoken of as absorb- 



CIRCULATION OF THE BLOOD 11 



ents as they absorb certain elements from the blood and 
distribute them to the tissues ; they also absorb waste from 
the tissues and convey it to the blood to be sent out of the 
system. 

RESPIRATION 

Respiration is the act of breathing. The organs con- 
nected with this process are : nose, mouth, trachea, lungs. 
There are two lungs, one on either side of the chest cav- 




LUNGS AND AlK-PASSAGES. 

a, larynx; 6, trachea; 
c, bronchial tubes. 



ity, each with its own covering called the pleura. The 
lungs are composed of a sponge-like substance made of air 
cells and blood vessels. They communicate with the outer 
air by means of the trachea which subdivides on reaching 
the lungs and forms the bronchial tubes in each lung. 

The larynx is the opening from the mouth to the 
trachea and is provided with a small lid-like covering 
which closes during the act of swallowing and prevents 
food being carried into the trachea. 

Respiration consists of two parts, inspiration — or 



12 PRACTICAL HOME NURSING 



drawing the air in, and expiration — or driving the air 
out — but the lungs are never entirely emptied. A large 
percentage of oxygen is breathed in from fresh air which, 
mixing with the blood, purifies it; and in the circulation 
of the blood, this oxygen is conveyed to the tissues. A 
large percentage of carbon dioxide is breathed out, thus 
removing waste from the body which has been gathered 
from the tissues in the circulation of the blood. The ex- 
haled air is always the temperature of the body and in 
this way a certain amount of heat and moisture is con- 
stantly being lost and the body cooled off. 

Counting respiration. Observe the rise and fall of 
the chest (which constitutes one breath) and count for a 
full minute, or for half a minute and double the number. 
It is better to count this immediately after taking the 
pulse and while the hand is still on the wrist as the breath- 
ing is more natural when the patient is not conscious of its 
being counted. There is usually about one respiration to 
four heart beats. 

Table of Respiration 

Normal 18 per minute 

Limits of normal . . . 16-22 per minute 

Fast 30 per minute 

Very fast 40 per minute and up 

Points to notice about respiration : 
Its frequency; 

Its regularity — or irregularity ; 
Is it quiet, labored, or noisy ? 
Note : See emergencies for artificial respiration. 

PULSE 

Pulse indicates the heart beat. When the heart con- 
tracts, it forces the blood into the arteries, and whenever 
an artery approaches the surface, the pulse can be felt. 



CIRCULATION OF THE BLOOD 13 



This is usually counted at the radial artery on the thumb 
side of the wrist ; also at the temporal artery on the lower 
side of the forehead, or at the femoral artery in the groin. 

Method of counting. If taking the pulse at the radial 
artery, have the arm extended and resting on some sup- 
port; make slight pressure on the artery with the index 
and middle finger, and count by tens for a full minute, 
dividing the count at the half minute to compare the fre- 
quency of the beat with the next half minute. 

Another method is to count for a half minute and 
double the number. 

Easy method of counting pulse: 
1, 2, 3, 4, 5, 6, 7, 8, 9,-10 
1, 2, 3, 4, 5, 6, 7, 8, 9 — 20 
1, 2, 3, 4, 5, 6, 7, 8, 9,— 30— and so on. 

Table of Pulse 

In adults : 

Normal 72 per minute 

Limits of normal .... 60-80 per minute 

Eapid 100-120 per minute 

Very rapid 130-140 per minute and up 

In children : 

Infancy — at birth . . 130-140 
First two years, about 120-110 (at end of second 

year) 

2d to 5th years 10*0-90 

5th to 12th years 90-80 

It is generally found that a man's pulse beats more 
slowly than a woman's. 

During sleep the pulse rate is slower. 

Some points to observe regarding pulse are whether it is : 
fast or slow*, 



14 



PRACTICAL HOME NURSING 



regular or irregular or intermittent, 
strong or feeble. 



Some causes that hasten pulse are: 



fever excitement 
exertion position 
nervousness sex 



Pulse beats faster when a person is in a standing posi- 
tion, and slower when lying down, so whenever it is neces- 
sary to save a strain on the heart, keep the patient lying 
down, or, if necessary to raise a patient who has a weak 
pulse — do it with a steady, slow movement. There 
never is an increase of temperature without an increase 
of pulse, usually at the rate of ten beats for the rise of 
each degree of temperature, but there can be an increase 
of pulse-rate without a rise of temperature. 



Temperature is the heat of the body. The blood keeps 
the body warm and the action of the skin, by the evapora- 
tion of the watery part of perspiration, keeps the heat 
from accumulating. This is aided by the accumulation 
and loss of heat in the act of breathing, and also by the 
loss of heat in the fluids eliminated from the body. Thus 
a normal temperature is maintained in health. 

Rise of temperature is caused either by overproduc- 
tion or by imperfect loss of heat. Change of temperature 
may be the first symptom of disorder and should be care- 
fully watched. 



TEMPERATURE 



Table of Temperature 
(In Adults) 



Normal 

Limits of normal 
Fever 



98.4° 
98-99° 
100 — up° 



CIRCULATION OF THE BLOOD 



15 



High fever . . . . 
Very high fever 



103° 
105° 



Subnormal 
Very low 



Below 98° 
96° 



(In Children) 



Normal 



98.5°-99° 



Temperature of the body is lowest between midnight 
and 5 a. m. It is highest between 5 a. m. and 10 p. m. 

In convalescence, a patient is likely to have a subnormal 
temperature in the morning for some time, owing to lack 
of vitality. 

Taking temperature of the body. The heat of the 
body is gauged by taking the temperature with a clinical 
thermometer which differs from the ordinary thermometer 
by remaining at the point reached until shaken down and 
it has a range only from 94-110 degrees. To shake the 
mercury down, place the stem of the thermometer between 
the first and second fingers with the bulb downward and 
hold it with the thumb, and give the hand a sharp jerk. 
In all cases before taking the temperature, the ther- 
mometer should be cleansed with water or alcohol and the 
mercury shaken down to 96°. 

The temperature may be taken by mouth, rectum or 
axilla (under the arm). 

Methods of taking temperature. By mouth. 
Place the bulb of the thermometer under the patient's 
tongue, touching the mucous membrane of the mouth, 
and keep it there from 2-3 minutes, having the lips 
closed during this time. Remove from the mouth, read 
and record the temperature. Nothing hot or cold should 
have been taken into the mouth for at least ten minutes 
beforehand. 

By rectum. This method is the most accurate and 
usually records a temperature one degree higher than by 
mouth. It is used for children, very sick people or in 
cases where the mouth cannot be kept closed. Oil the 



16 



PRACTICAL HOME NURSING 



bulb of the thermometer and insert about 2 inches into the 
rectum and hold in place for 2 or 3 minutes. 

By axilla. Place the bulb of the thermometer in the 
hollow under the arm, touching the skin, and hold the arm 
over the body. Keep the thermometer there for 5 min- 
utes. This will register about a degree lower than by 
mouth. 

To disinfect a thermometer wash it in soap and water, 
not hotter than 105°, then in alcohol. 

To test a thermometer, place it with another in warm 
water at a temperature of 105° and see if both reach the 
same point at the end of two minutes. 

If a thermometer should be broken while in the mouth, 
have the patient immediately rinse out the mouth thor- 
oughly to remove broken glass and mercury, and give olive 
oil at once. 

To reduce fever without medicine. Ma^e the skin 
act by bathing with tepid or cold baths, keeping cold to 
the head. Have the patient in a cool room, under light 
covering, with fresh air and plenty of fluid to drink. 
Also give a very light diet and provide for a free action 
from the intestines. 

To raise the temperature. Apply heat, either hot 
water bottles or bags (covered), taking care not to burn the 
patient, or hot blankets wrapped closely around patient; 
hot drinks — such as ginger tea, coffee, tea or alcohol (of 
the latter a tablespoonful of whiskey in a little hot water). 
Keep the patient lying down to save the heart action. 



CIRCULATION OF THE BLOOD 17 



QUESTIONS 

By what means is circulation carried on ? 
Describe the heart. 

Trace the circulation of the blood from the left side of the 

heart back to the same point. 
What are the functions of the capillaries? 
What is the difference between arteries and veins ? 
Name the largest artery — largest veins. 
Describe the lymphatics. 

In what direction does the blood in veins flow ? 
What are the respiratory organs ? 
Describe the lungs. 

How is waste of body removed by the lungs ? 

How many heart beats to one respiration ? 

How does air reach the lungs ? 

What is normal respiration for adult ? 

Give rate of normal pulse in adult — in child. 

How is the pulse affected by rise of temperature ? 

Mention causes that decrease the pulse rate. 

Where can the pulse be counted ? 

Mention causes that increase the pulse rate. 

What keeps the temperature of the body normal ? 

From what is the heat of the blood derived ? 

Give normal temperature for adult. 

How reduce fever without medicine? 

How raise a subnormal temperature ? 

Describe methods of taking temperature. 



CHAPTER III 



THE URINARY TRACT 
Urine 

Urine is the principal waste matter of the body and is 
separated from the blood by the kidneys and carried out 
of the system through the urinary tract. Its chief solid 
constituent is called urea and it also contains a large pro- 
portion of water — about 95 per cent. — and uric acid, col- 
oring matter and salts. 

The kidneys are two small, bean-shaped organs, about 
four inches long by 2y 2 inches wide, situated in the small 
of the back on either side of the spine at the waist line. 
The urine passes from them to the bladder through two 
narrow tubes, 12 to 18 inches long, called ureters. 

The bladder is in the lowest part of the abdomen, at 
the front of the pelvic cavity and acts as a reservoir for 
the urine. It has a capacity of about one pint. The 
urine passes from this through a small, muscular tube 
called the urethra to the meatus, or mouth. In the fe- 
male, the urethra is iy 2 inches long. 

It is very necessary that the kidneys be unimpeded in 
their chief work — that of carrying off the urea, — lest this 
waste matter be carried back by the blood and poison the 
entire system. 

The normal amount of urine passed by an average 
healthy adult in 24 hours is about 3 pints, and the color 
should be light amber. But the amount passed may be 
temporarily increased or decreased by various causes, in 
health as well as in sickness. The amount may be in- 
creased by drinking a quantity of fluid, by lessened per- 
spiration or by emotion ; and usually when more is passed, 



THE URINARY TRACT 



19 



its color is lighter. The amount may be decreased when 
less fluid is taken into the system, when the skin perspires 
freely and, usually, when a person is suffering from fever 
or from some form of kidney disease. 

Always observe any change in the color, quantity and 
frequency in passing of the urine as this often points to 
conditions in the system which might otherwise pass un- 
noticed. Also note if there is any distress in passing it. 

Suppression of urine is caused by the kidneys failing 
to act. 

Retention of urine is caused by the failure of the blad- 
der to expel its contents. 

Incontinence is the failure of the bladder to retain its 
contents. 

Plenty of water should be given to sick people, par- 
ticularly in cases of fever and when changing from a 
fluid to a solid diet. 

Difficulty in passing urine. There is frequently 
some difficulty in passing urine from the bladder. This 
may be either from weakness of the urethra, or contraction 
of the muscles, and in such a case the patient may be 
helped to expel the urine by some of the following aids : 

(1) if allowable, raise the patient to a sitting position; 

(2) apply heat over the bladder or between the thighs, or 
put hot water in the bed pan; (3) give a hot drink; (4) 
give a hot, simple enema; or (5) if the patient is nervous, 
go out of the room and leave her alone. If necessary to 
use any further treatment, a doctor should be consulted. 
Report if the patient cannot pass urine at the end of 12 
hours. At any time, if doubtful of a sufficient amount of 
urine being passed, measure it in a graduated measuring 
glass or some substitute. 

Specimen of urine. To secure a specimen of urine 



20 PRACTICAL HOME NURSING 



for analysis. First, wash off the part and then have the 
patient pass urine into an absolutely clean vessel. From 
that amount, take 8 ounces and place in a sterile (boiled) 
bottle, cork, and label with patient's name and send imme- 
diately for analysis. 

If a 24-hour specimen is wanted, keep in a clean bottle 
or vessel, and collect all the urine passed in 24 hours. To 
secure this accurately, have the patient empty the bladder 
at 9 a. m., for instance. Do not count that at all, but 
start the record from that hour and keep it until 9 a. m. 
the next day. 

QUESTIONS 

Define urine and state from what it is derived. 
Describe the kidneys and state their function. 
What is the position of the bladder ? 

What is the function and what the capacity of the bladder ? 

State the normal amount of urine passed in 24 hours. 

How relieve retention of urine ? 

How relieve suppression of urine? 

Describe method of securing a 24-hour specimen. 

Name the constituents of normal urine. 



CHAPTER IV 



THE DIGESTIVE TRACT 



The Process of Digestion — The Food Principles — Diet 

The digestive tract is known as the alimentary canal 
which is about 28 feet long and divided into different 
portions : 



The digestive process all takes place in the alimentary 
canal. 

The liver and pancreas are accessory organs which 
send their juices into the small intestines. (See digestive 
process.) 

Digestion is a mechanical and chemical process by 
which foods are changed to prepare them for absorption 
by the tissues. The mechanical part is largely mastica- 
tion by the teeth and the action of the muscles throughout 
the different parts of the tract; the chemical part is the 
effect produced on the food by the different digestive 
juices. 

Absorption is the taking up of food into the tissues 
when digested, and making it into a suitable solution for 
absorption by the blood. 

Peristaltic action is the movement made by the con- 
traction and relaxation of the muscles of the stomach and 
intestines. 



Mouth 



^Esophagus 
Stomach 



Small intestines 
Large intestine (which 
ends in the rectum) 



21 



22 PRACTICAL HOME NURSING 



DIGESTIVE JUICES 

Mouth Saliva 
Stomach Gastric juice 

Intestine Intestinal juice 

Liver Bile 
Pancreas Pancreatic juice 

FUNCTION OF THE DIGESTIVE ORGANS 
Mouth. The functions of the mouth are to secrete the 
saliva in the salivary glands (this chemically affects cer- 
tain food elements), and to masticate and make food more 
soluble. 

Stomach. The stomach secretes the gastric juice in 




Alimentary Canal. 

6. Bile duct, 
p. Pancreatic duct. 



THE DIGESTIVE TRACT 



its glands, (this chemically affects certain food elements). 
It makes food soluble, assists in digestion and has some 
power of absorption. 

The liver. The liver secretes the bile, stores it in the 
gall bladder, and from there it is sent through a duct as 
needed to the small intestines to assist in digestion. The 
bile also serves as an antiseptic to the intestines. 

The pancreas. The pancreas secretes the pancreatic 
juice and from there it is sent through a duct to the small 
intestines to act as a digestive juice in chemically affecting 
food. 

Small intestines. The functions of the small intes- 
tines are to secrete intestinal juice (which chemically af- 
fects food), to receive the bile and pancreatic juice, to 
finish the digestive process of all food not previously di- 
gested, and to absorb most of the product of food. 

Large intestine. The function of the large intestine 
is to absorb some of the product of food, particularly 
fluids, and to pass the residue on and out of the body 
through the rectum. 

FOOD AND THE DIGESTIVE PROCESS 

Food is a substance essential to the body and com- 
bined with oxygen in the air makes the motive power that 
sustains life. Food contains the chemical elements sim- 
ilar to those found in the composition of the body and 
after the process of digestion has taken place, the product 
of food is in a condition to replenish or build up these 
tissues and become part of them. The combination of 
food with the oxygen of the air causes combustion which 
creates the heat and energy in the body necessary for work 
or activity of any kind. A proper proportion of all classes 
of food is required to maintain health. 

Food adjuncts, such as flavoring, spices, etc., have no 
nutritive value but they stimulate the appetite and help 
make variety in the taste of food. 



24 



PRACTICAL HOME NURSING 



THE FIVE FOOD PRINCIPLES 



Principles 
Proteins 



Fats 



Examples 
Lean of meat, 
Albumen of fish, 
Curd of milk, 
Gluten of bread, 
Egg- 

Cream, fat of meat, 
Butter, oil. 



Functions 

To build up and 
repair muscular 
tissue. 



Carbohydrates 



Mineral salts 



Water 



Starch, sugar, 
Fruit, cereals, 
Starchy vegetables. 

Iron, phosphates, 
lime (in many 
foods). 

In all foods. 



To yield heat, 
Create energy, 
Build up fat 

tissue. 
To yield heat, 
Create energy, 
Store up fat 

tissue. 
To build up bone 
and other tis- 
sues and keep 
blood normal. 
As a solvent and to 
form part of all 
tissues and 
fluids. 

Food may be classified chemically as : 

Organic — Proteins, fats, carbohydrates. 
Inorganic — Mineral salts and water. 

It may also be classified as : 

Nitrogenous (meaning proteins). 
Non-nitrogenous (meaning all other classes of 
food). 

In regard to their source, foods are divided into 
Animal (and this includes their products), 
Vegetable, and 
Mineral. 



THE DIGESTIVE TRACT 



25 



PROCESS OF DIGESTION OF FOOD 
ELEMENTS 

The mouth. In a mixed diet, all food is first made 
partly soluble iu the mouth by being chewed with the 
teeth and mixed with the saliva (the digestive juice of 
the mouth), and the starches are changed into sugar by the 
chemical action of the saliva upon them. 

The aesophagus. The food, after being swallowed, 
progresses through a tube called the aesophagus to the 
stomach. 

The stomach. In the stomach all food is made soluble 
and changed by being mixed with the Gastric juice com- 
bined with the muscular action of the stomach, and the 
digestion of the proteins is largely affected by the chemi- 
cal action of the gastric juice. The semi-solid substance 
which represents food after the changes in the stomach 
have occurred is known as Chyme. 

Small intestines. The food then passes to the small 
intestines and comes in contact with three juices: 

Bile, from the liver ; 

Pancreatic juice, from the pancreas ; 

Intestinal juices, secreted in the small intestines. 

The fats, which have not previously been affected to any 
extent, are here digested ; the digestion of all food is here 
completed, and absorption of the food products follow. 
The milk, like fluid which represents food after undergoing 
the process of digestion in the intestines is known as 
Chyle. 

Large intestine. The absorption of some of this food 
and also of most of the fluids taken into the body continues 
all the way down the large intestine, and what is not ab- 
sorbed, passes off out of the rectum as waste or fecal mat- 
ter. In all food there is meant to be a certain amount of 
waste or bulk which is not absorbed and when this reaches 



26 



PRACTICAL HOME NURSING 



the large intestine, it stimulates the muscular action there 
and prevents an accumulation of residue which, if too long 
in the intestines, may cause a reabsorption of it into the 
system with bad results to the general health. 

DIET 

A diet comprising all five elements of food is best in 
health and as far as possible in time of sickness, but in 
the latter case sometimes a restriction or an elimination of 
one class of food is ordered because it cannot be digested 
and assimilated properly in the system under the existing 
conditions of the illness. To diet a person in any case is 
to prevent elements of food being put into the body which 
cannot be taken care of there. 

Diet in disease. The principles governing diet in dis- 
ease are : 

(1) To give as much nourishment of the right kind as 
can be assimilated and at the same time try to provide suf- 
ficient bulk to stimulate the intestines to act normally: 

(2) To give a sufficient amount of water; 

(3) To restrict or eliminate any one class of food, the 
waste of which cannot be thrown off through the channels 
by which waste is usually removed from the body ; 

(4) To restrict foods which are causes of irritation to 
the system in general or, to any one organ in particular, 
such as the stomach, kidneys, intestines, etc. 

(5) To restrict elements which cause undue acidity. 

In acute diseases the diet is usually ordered by the physi- 
cian, while in convalescence and simple cases of illness 
it is left more to the judgment of those taking care of 
the patient. A highly condensed protein food and cereals 
reduced to flour are rather constipating, while fats, coarse- 
grained cereals, bread, green vegetables and fruit, tend to 
prevent constipation. 

In time of illness, food is generally given at shorter in- 
tervals, in smaller quantities, and in more condensed form 



THE DIGESTIVE TRACT 



27 



than in health, and the heaviest meal is served in the 
middle of the day. 

Amount. The amount is sometimes regulated by order, 
but as a general rule it is better to offer too little rather 
than too much, especially in trying to tempt the appetite. 

If the amount is estimated in calories (a calory being 
a heat unit or measure of heat) it means that a sufficient 
allowance of certain elements in food is made to supply 
the necessary heat and energy used up by the body. 

Care of food. Food for an invalid particularly must 
always be pure, fresh and clean, and, as bacteria easily 
develops in it, should be kept covered and cold. Meat, fish 
and milk are particularly susceptible to decomposition. 

Choice and preparation of food. The value of food 
that can be easily digested and assimilated is a very im- 
portant factor in reestablishing health. It should be pre- 
pared and served in such a way as will tempt the appetite 
by appealing to the sense of taste and sight, and meeting 
the personal desires of the patient as far as practical. 

Varying the diet. Make food interesting to the 

patient by varying the diet as much as is allowable under 
the circumstances of the illness. Also vary the way of 
cooking the same articles of food and serve in dainty, un- 
expected ways. Even bread can be of different kinds and 
varied in the way it is cut and arranged. If the patient 
has a persistent craving for something which can do him 
no actual harm this craving should be satisfied if possible, 
as the monotony of diet is trying to a patient. 

Serving food. Meal times are important events to a 
patient, affording as they do an opportunity to make a 
break in the monotony of the sick room, and should be made 
cheerful and agreeable. Before serving a meal have the 
patient rinse out the mouth and arrange her in a com- 
fortable position with the head and neck supported by 
pillows, and the tray placed conveniently either on an 



28 PRACTICAL HOME NURSING 



improvised stand or upon a bed table stretched across the 
bed and adjusted to the proper height, or on a bed tray. 
A substitute for the latter can be made with a board resting 
on supports on either side of the patient to keep the weight 
off the knees. 

Arranging tray. Arrange the tray in an attractive 

manner and to look like a well set place at a table, not too 
crowded, the linen clean, the silver bright, and as dainty 
china as can be obtained, if possible with a colour scheme 
in the dishes. Well selected flowers add an interest. 
Serve cold foods cold and hot foods hot. Heat cups 
meant to contain hot fluids beforehand, and serve hot food 
on a hot water plate, which is a china plate set over an 
aluminum deep dish fitted with a spout and screw top in 
which boiling water can be placed to keep the food hot on 
the plate. This can be substituted by a heated plate 
placed over a bowl of very hot water. 

Feeding a helpless patient. In feeding a helpless pa- 
tient, allow plenty of time so that there may seem no neces- 
sity for hurrying. Support the head at a convenient 
angle on the pillow, not bending it too far forward. Place 
the food on the tongue and not just inside the lips. If a 
patient is able to drink fluid, have the glass only about two- 
thirds full (so as not to spill it) or use an invalid's cup 
with a partial cover. Another method is to use a bent 
glass tube with one end in the fluid. The glass containing 
the fluid can most conveniently be placed in the hollow of 
the patient's arm so that the tube may reach the mouth 
easily. As a substitute for the glass tube, a straw or a 
piece of clean rubber tubing with a glass tip may be used. 

CLASSES OF FOOD 

In regard to its source, food is divided into animal, 
vegetable and mineral, while water exists in all foods. 



THE DIGESTIVE TRACT 



29 



Water 

About two-thirds of the body consists of water. A 
certain amount of water independent of the fluid contained 
in food is essential in illness as well as in health, (1) to 
flush out the system, (2) to remove worn-out tissue and 
(3) to assist in assimilating food. At least two quarts 
of liquid in some form should be taken as the minimum 
amount in twenty-four hours, some of which is included 
in beverages with food. 

Under ordinary circumstances the available drinking 
water is considered pure though it should be filtered. 
Where possible its source should be carefully investigated 
and if there is the slightest doubt as to its purity, particu- 
larly in times of epidemics, it should be boiled to destroy 
any harmful bacteria in it. In order to avoid the flat 
taste, consequent to boiling, it may be boiled for only two 
minutes, then shaken from one vessel to another to re-aer- 
ate it. Water can also be purified by being sterilized in 
the upper part of a double boiler, the water in the lower 
part of which should be kept boiling for an hour. 

A great deal of water is given in the form of beverages 
such as orangeade, lemonade, tea, etc., which may appeal 
more to the patient than plain water. It is -sometimes 
ordered in the form of alkaline mineral, or charged water, 
such as vichy. 

What is known as " hard " water generally contains a 
great deal of mineral deposit and this is constipating. 
This hardness can be corrected by boiling which tends to 
cause the mineral salts to settle in a deposit, or bicarbonate 
of soda can be added to soften hard water. 

Ice. As freezing does not destroy all germs and only 
renders some of them temporarily inactive it is important 
to have ice come from pure water. If the water for arti- 
ficial ice is pure that will be quite safe to use. All ice 
should be washed before being placed in the ice box. This 
box requires to be kept thoroughly clean as particles of 



30 



PRACTICAL HOME NURSING 



food, combined with the melting ice, accumulate in the 
piping where bacteria may develop. This piping can be 
cleaned with boiling hot soda and water to dissolve any 
grease that may have been deposited there. 

Animal food 

Animal food is used in the forms of flesh of animals, 
fowls and fish, and in the juices extracted from them and 
also their products such as eggs, milk, etc. 

Milk. Milk is largely used in the food of invalids as 
it can usually be changed, if necessary, to suit the diges- 
tion of the individual patient, can be easily taken, is a 
good medium for other food and in itself contains all of 
the food elements in the following proportions: 

Water ..8 7 per cent. Fat 4 per cent 

Protein . 3.3 per cent. Carbohydrate. . 5 per cent. 
Mineral . .07 per cent. 

The fats and sugars are in a particularly digestible form 
and the mineral salts in good proportion. The curd of 
milk, or the protein, is less digestible in proportion to the 
other constituents and the milk has often to be changed on 
this account to suit a patient's needs. 

Milk should always be taken slowly so that the curds 
formed in the process of digestion (which solidifies the 
curd first) will not become too large and cause distress, by 
preventing the gastric juice acting on them. 

The amount of water in milk is sometimes considered 
a disadvantage on account of its bulk. 

It is essential that milk should be pure and kept cov- 
ered and cold as it absorbs bacteria very easily particu- 
larly between the temperature of 70° and 100°. 

Methods of purifying milk. 

Pasteurizing — which means mantaining a heat of 
140° for half an hour to destroy most harm- 
ful germs. 



THE DIGESTIVE TRACT 31 



Sterilizing — means a heat of 212° from /4 to 1 

hour and destroys all germs. 
Scalding — at a temperature of 180° destroys 

germs that cause fermentation or souring. 
(See method for above on page 36.) 

Suggestions for altering the conditions in milk to suit 

the individual needs of a patient: 



Diluted milk 
Milk with lime water 
Milk with soda 
Milk with vichy 



to counteract too much 
acidity 



Peptonized — predigested milk. 
Milk with salt. 

Kumyss — a fermented milk (which alters the con- 
dition of the curd). 

Matzoon or Zoolak — fermented milk. 

Buttermilk — containing less curd and sugar and 
more fat than skimmed milk. 

Whey — containing little nourishment but easily di- 
gested and slightly acid in taste. 

Milk added to bread or cereal aids its digestion by 
preventing too large curds being formed. 

Junket and some custards serve as milk substitutes. 

Milk diet. A diet entirely of milk is sometimes or- 
dered in an amount varying from 6 to 8 ounces at inter- 
vals of two or three hours. The following are suggestions 
for varying a milk diet : 



32 



PRACTICAL HOME NURSING 



r Dried milk 
Hot milk (not boiled) Oval tine \ Cocoa 

Cool milk L Cereal 

Buttermilk Malted milk 

Matzoon or Zoolak Condensed milk 

Fermilac Milk flavored with coffee, 

Ice cream nutmeg, chocolate, etc. 

Egg-nog Albumenized milk 

Milk 2 parts, club soda 1 Milk toast 

part Milk and gruel (barley and 

oatmeal ) 

Eggs. Eggs contain all the food elements except car- 
bohydrates and are usually taken in combination with 
them. They are considered especially valuable as con- 
taining nourishing elements in a condensed form and are 
easily digested under most conditions. The albumen or 
white of egg raw, is combined with many beverages and the 
entire raw egg is largely used in the diet of invalids. In 
order to make cooked eggs easily digestible they must be 
cooked at a low temperature to prevent the albumen of 
the egg becoming tough. (See page 41.) 

Vegetable food 

The vegetable class of foods consists of the product of 
vegetation or plant life, such as grains which supply the 
material for bread and cereals, also starch, green vegeta- 
bles, fruits, and the various forms of sugar derived from 
them, as well as nuts and their derivatives. 

Mineral food 

Minerals are found in practically all foods in varying 
quantities in such forms as iron, lime, phosphorus, etc., 
and a mixed diet provides this in necessary proportions. 

EXAMPLES OF DIETS 
Liquid diet. This would usually consist of milk, of 
broth, beef tea, beef juice, cereal or arrowroot gruel, albu- 
men water, orangeade, egg-nog, or other nourishing bever- 
ages. 



THE DIGESTIVE TRACT 



33 



Liquid Diet for Twenty-four Hours 

7 Hot milk flavored with coffee .... 6-8 ozs. 
9.30 Oatmeal gruel with 1 oz cream. .6-8 ozs. 



12 Egg-nog 6-8 ozs. 

2.30 Beef broth 6-8 ozs. 

5 Kumyss 6-8 ozs. 

7.30 Chicken broth 6-8 ozs. 

10 Hot milk 6-8 ozs. 

2 a. m. Hot milk 6-8 ozs. 



Soft diet. This includes puree of vegetables, cereals, 
rice, jellies, soft cooked eggs, raw scraped beef sandwich, 
milk toast, custards, soft puddings, etc. 

Breakfast Soft boiled egg, toast, milk with coffee. 

10 a. m. Chicken broth. 

Luncheon Scraped beef sandwich, baked custarc. 

4 p. m. Orange juice. 

Supper Cream toast, snow pudding. 

10 p. m. Hot milk. 

Convalescent diet. This includes the foods men- 
tioned above and scraped beef, slightly cooked, baked po- 
tato, cooked and raw fruit, green vegetables, oysters, fresh 
fish, bacon, squab, sweetbread, chicken, chops, steak, etc. 

Breakfast Grape fruit, cream of wheat cereal with 
cream, bacon broiled, toast, coffee. 

10 a. m. ^Orange juice in ice water for drink. 

Dinner Squab, spinach and egg, potato in shell, 
ice cream, sponge cake, black coffee. 

Supper Baw oysters, brown bread and butter, tea, 
blanc mange and cream. 

10 p. m. Hot milk. 



The change from one form of diet to another should be 



34 



PRACTICAL HOME NURSING 



gradual both in considering the amount and the variety, 
and plenty of water should be given when changing from 
a liquid to a solid diet. 

QUESTIONS 

Mention the organs connected with the process of digestion. 

What are the divisions of the alimentary canal ? 

Name the digestive juices. 

Define digestion — absorption. 

What is meant by peristaltic action ? 

What is the danger to patient of an unclean mouth ? 

How would you feed a helpless patient ? 

How may food become infected ? 

Name the food elements. 

Mention the functions of each. 

What foods stimulate the muscles of the large intestines ? 
How could you vary a milk diet ? 
Mention methods of changing conditions in milk. 
What is the general principle for restricting diet ? 
What are uses of water in the body ? 

Apart from food, mention conditions that affect digestion. 



CHAPTER V 

RECIPES 

Beverages 

Symbols : — tbsp. for tablespoon 
tsp. for teaspoon 
A level spoonful or cupful is meant in all cases. 

Lemonade 

Juice of 1 lemon or 3 tsp. of sugar 

3 tbsp. of lemon juice 1 cup of water or vichy 

Dissolve sugar in a little boiling water, add this to the 
juice and water and cracked ice. 

Albumen can be added. 

Orangeade 

Juice of 1 orange M> tbsp. of sugar 

1 cup of vichy 
Dissolve sugar in a little boiliug water, add to juice, and 
strain over cracked ice. 

Lemon or pineapple juice may be added. 

Albumen water 

White of 1 egg % cup of water 

Place in a covered jar or shaker. Shake thoroughly, 

strain and serve. This may be flavored with any fruit 

juice. 

To place cracked ice in the shaker breaks up the albu- 
men. 

Rice water 
3 tbsp. rice 1 pt. water 

Pinch of salt 

35 



36 



PRACTICAL HOME NURSING 



Soak rice in water 30 mins. 
Heat gradually to boiling point and cook 1 hour. 
Strain, dilute with boiling water or hot milk and season 
with salt. Sugar or flavoring may be added. 

Barley water 

2 tbsp. of barley flour to 1 pt. of boiling water 
Make flour into a thin smooth paste with cold water. 

Add boiling water to it very gradually, stirring rapidly. 
Boil over direct heat 5 mins., then cook % hour in a 

double boiler, stirring frequently. 

Strain through fine gauze strainer while hot. 

Peptonized milk 

% cup of cold water 1 pt. cold milk 

1 tube Fairchild's peptonized powder 

Cold process: Dissolve the powder in the cold water, 
add the milk, and place in a bottle and keep on ice. 

Warm process: Mix in same manner and keep the bot- 
tle surrounded with water at 115 degrees for 10 to 20 
minutes, depending on the degree of peptonizing required, 
cool quickly and keep on ice or lacking ice after above 
process bring quickly to boiling point to stop the action of 
the ferment. 

Pasteurized milk 

To pasteurize a bottle of milk, place it in a vessel of 
cold water, with a wire protector under the bottle, and 
bring the temperature of the water up to 140 degrees and 
keep it at that temperature, or between 140 and 145 for 
one-half hour. Cool immediately and keep on ice. 

For pasteurizing babies' bottles, a convenient form of 
apparatus is the Freeman pasteurizer, in which spaces are 
arranged for each bottle and directions for its use are 
given with it. 

Milk can be pasteurized in the upper part of a double 
boiler by using a thermometer and keeping the milk at 



RECIPES 



37 



the required temperature for % hour. Pasteurized milk 
should be used within 24 hours. 

Sterilized milk 

Milk can be sterilized in the same manner as above, 
except that the temperature must be at boiling point — 
212 degrees for % hour. Sterilized milk is supposed to 
be safe for 48 hours, but sterilization is destructive to the 
value of the milk. 

Wine whey 

1 pint milk 2 tbsp. sherry wine 

1 tsp. sugar 

Pour the wine into the warm milk and cook over boiling 
water about five minutes, or until the curd separates from 
the whey. Strain through fine cheese cloth and sweeten. 
Serve hot or cold. 

Lemon whey 

1 pint milk 2 tbsp. lemon juice 

2 tsp. sugar 
Prepare in the same manner as wine whey. 

Rennet whey 

1 pint milk 2 tsp. rennet 

1 tsp. sugar 

Heat the milk until lukewarm, add the sugar and stir 
until dissolved, add rennet; leave until firm, about 20 
minutes. Break the curd and strain through fine cheese- 
cloth. Flavor if desired. 

Milk punch 

1 cup milk V2 tbsp. sugar 

1 tbsp. rum or brandy 
Place all the ingredients in a covered glass jar, shake 
until thoroughly blended. 

Tea 

1 pint boiling water 2 tsp. tea 



38 



PRACTICAL HOME NURSING 



Heat a small teapot. Place the tea in it and pour 
freshly boiling water over it; steep a few minutes and 
strain. It may be served hot or cooled and iced, with 
lemon or cream. 

Boiled coffee 

2 tbsp. coffee Small pieces of egg shell 

1 tbsp. cold water 1 pint boiling water 

Mix the coffee with the cold water, and shells. Add 
boiling water. Boil 1 minute, remove to back of stove. 
Add a little cold water to settle it. 

Cocoa 

2 level tsps. cocoa X A cup water 
Sugar to taste 1 cup milk 

Mix cocoa and sugar, add the cold water and boil di- 
rectly over fire 3 minutes. Then stir into the milk and 
cook 5 minutes over hot water. 

TOAST 

Toast is bread in which the starch has been changed to 
dextrin, which is the most easily digested form of starch. 

Cut a slice of stale bread % inch thick, put it on a 
toaster and let it gradually dry, then allow it to become a 
light brown by placing it nearer the heat. It may be 
toasted in the oven. 

Milk toast 

1 cup hot milk 1 slice toast buttered 

Pinch of salt 

Dissolve the salt in the hot milk and pour over toast cut 
in squares. 

Cream toast 

1 tbsp. butter 1 cup of milk or cream 

1 tbsp. flour Pinch of salt 

2 slices of toast 

Heat butter, add flour and salt, stirring until thoroughly 
blended. Add the milk gradually, bring it to a boil, and 
boil for two minutes. Pour over the toast and serve. 



RECIPES 



39 



Corn meal gruel 

1 tbsp. com meal 1 pt. water 

Pinch of salt 

Sprinkle meal into the boiling salted water, cook over 
direct fire 10 minutes, stirring constantly, then over boil- 
ing water 1 hour. Add cream and serve. 

Oatmeal flour gruel 

2 tbsp. oatmeal flour _ 1 pt. water 

Pinch of salt 

Mix flour in cold water and stir into boiling water, 
cook 5 minutes over direct fire, then continue over boil- 
ing water in a double boiler % hour. Strain and flavor to 
taste. 

Cracker gruel 

1 tbsp. sifted cracker 1 cup hot milk 
crumbs Pinch of salt 

Sweetening to taste 
Pour hot milk gradually on to cracker crumbs, stirring 
constantly. Cook in double boiler five minutes. 

Rice brule 

1 tbsp. rice 1 qt. milk 

Salt to taste 

Parch the uncooked rice deep golden color in a clean, 
dry frying pan, shaking and stirring all the time. Add 1 
qt. of milk with a pinch of salt and put in a double 
boiler and cook till reduced to about half the quantity or 
until the mixture is creamy. Cool and put on ice. Can 
be served hot or cold. 

Rice boiled and steamed (Southern) 

Take 1 cup of rice and sprinkle into a large saucepan 
half full of boiling salted water, boil 15 to 20 minutes 
until slightly soft, then strain into a colander and rinse off 
with cold water. Leave rice in the colander and place 



40 



PRACTICAL HOME NURSING 



over boiling water, cover and steam % hour. Each grain 
will be whole, dry and tender. 

Beef tea 

1 lb. beef makes 1 pt. beef tea 
Chop 1 lb. beef very fine, place in upper part of double 
boiler and cover with cold water. Soak for 2 hours, then 
place upper part of double boiler over cold water on the 
fire, which gradually heats. Stir frequently and when 
the beef tea is a reddish-brown, pour off and season, re- 
moving fat. This may be served hot or cold. 

Beef juice 

1 lb. beef makes 4-6 ozs. of beef juice 
Take 1 lb. of beef and sear over the fire or in a hot oven. 
Cut into small pieces and press out the juice, using a meat 
press which has been heated. Season with salt and serve 
either hot or cold. 

Starch free soup 

1 cup chicken broth A little finely chopped pars- 
/4 cup milk ley 

2 tbsp. cream or piece of 
butter 

Salt to taste 

Pour all these into a saucepan — bring to a boil, cool 
to medium heat then add 1 egg well beaten. Cook 
slightly over hot water, and serve. 

Chicken broth 

3 lbs. chicken 3 pts. water 

Allow 1 lb. — 1 pt. of broth 
Thoroughly clean a chicken, remove skin and fat, wipe 
with a damp cloth, separate joints and put in a kettle and 
add cold water. Let stand 1 hour. Heat slowly and sim- 
mer 3 hrs. or until meat is tender. Strain and season and 
when cold remove fat. 



RECIPES 



41 



Oyster stew 

1 cup milk 1 tsp. butter 
6 oysters Salt 

Pepper 

Heat milk. Cook and strain the oyster juice. Add 
oysters and cook until the edges curl. Add seasoning, but- 
ter and hot milk. Serve at once. 

This soup may be thickened with one teaspoonful flour 
cooked in the butter as for white sauce. 

Scraped beef balls 

2 tbsp. scraped beef Salt and pepper 
Chopped parsley Onion juice 

Scrape the meat from the connective tissue with a dull 
knife or spoon. Season and make into little balls and 
broil or pan broil. Garnish and serve hot. 

Scraped beef may also be used raw in sandwiches. 

Cold egg-nog 

1 egg Sugar to taste 

1 cup milk Flavor to taste 

Beat the egg, add sugar, then the milk and flavoring 
and strain. 

Egg lemonade 

1 egg 2 tbsp. lemon juice 

1 tbsp. sugar 1 cup cold water or vichy 

Beat the egg, add sugar and lemon juice — then the 
water gradually stirring until blended. 

Soft cooked egg 

Place the egg in 1 pt. boiling water, remove from fire, 
cover and allow it to stand from 3 to eight minutes in 
saucepan where the water will keep hot but not boil- 
ing. 

3 minutes — very soft 6 minutes — medium 

10 minutes — firm 



42 



PRACTICAL HOME NURSING 



Poached eggs 

Break the egg into a saucer. Slip the egg into boiling 
salted water at simmering point and cook until firm. 
Serve on a slice of toast. Season. 



Omelet 

1 egg 1 tsp. butter 

1 tbsp. milk Salt and pepper 

Beat yolk and white separately. Add seasoning and 
milk. Heat an omelet pan, rub with butter. Turn in 
omelet. When it is set and browned, fold over and serve 
at once. 



Baked custard 

1 e ££ 4 tsp. sugar 

1 cup milk Pinch of salt 

Flavoring to taste 
Beat eggs, add sugar and salt. 

Add scalded milk slowly. Flavor and bake in custard 
cup m a pan of hot water until set, about 20 minutes. 

To test when done, dip a pointed knife into water,' then 
plunge m middle of custard. If knife comes out clean the 
custard is done; if milky it is not cooked enough. If 
cooked too long, custard will curdle. 



Egg cream 

J uice % lemon 2 eggs 

2 tbsp. sugar 

Separate yolks and whites. Beat yolks with sugar until 
well mixed, add lemon juice and place bowl in dish of hot 
water over the fire Stir slowly until it begins to thicken, 
then add beaten whites and stir until the whole forms a 
thick cream Remove from fire, pour into dishes and set 
aside to cool. 



RECIPES 



43 



Rennet or junket 

1 pint milk Vanilla to taste 
y 2 tbsp. liquid rennet or 1 tbsp. of sugar 

half a junket tablet 
Heat the milk until lukewarm, add sugar and vanilla 
and rennet. Pour into a dish, leave until firm, then put 
in ice box. Sprinkle with nutmeg. Serve with cream. 

Lemon jelly 

3 tsp. gran, gelatine 1 pint boiling water 

2 tbsp. cold water 3 tbsp. sugar 

4 tbsp. lemon juice 
Soak the gelatine in cold water, add the boiling water, 
sugar and juice, stir until sugar is dissolved, strain and 
cool. 

Orange jelly 

3 tsp. gran, gelatine 3 tbsp. sugar 

2 tbsp. cold water 1 cup orange juice 

1 cup boiling water 1 tsp. lemon juice 
Same method as for lemon jelly. 

Coffee cream 

2 tsp. gelatine % strong coffee 

4 tbsp. cold water 4 tbsp. sugar 

1 cup cream 

Soak the gelatine in cold water until soft, then add the 
hot coffee and the sugar. When gelatine is dissolved and 
begins to thicken, add the cream which has been previously 
whipped, then pour into a glass dish. 



CHAPTER VI 



VENTILATION 

Ventilation means the substitution of pure for impure 
air in any enclosed space. The chief constituents of air 
are nitrogen, oxygen and carbon dioxide. Of these, 
oxygen is the element that supports life, but can only be 
breathed in combination with the other natural elements 
of the air. The amount of nitrogen is the same in the air 
breathed in and in that breathed out, the chief difference 
being in the excess of oxygen taken in with fresh air, and 
in the excess of carbon dioxide exhaled from the lungs. 

Inspired air : 

Nitrogen 79 per cent. 

Oxygen 20.96 per cent. 

Carbon Dioxide 04 per cent. 

Expired air: 

Nitrogen 79 per cent. 

Oxygen 16.03 per cent. 

Carbon Dioxide 4.38 per cent. 

Carbon Dioxide is the element produced by the com- 
bination of oxygen with a substance or any element in a 
substance with the consequent result of creating heat or 
combustion. 

This heat is generated in animal life and gives the sup- 
ply necessary to create energy. It also results from the 
processes of fermentation and from decomposition of ani- 
mal and vegetable matter. The greater part of this gas 
breathed out from animal life is utilized by plant life 
which in turn gives off oxvgen to animal life/ 

44 



VENTILATION 



45 



Impurities of inside air. The impurities of inside air 
are largely the result of perspiration, respiration and of 
combustion, which is constantly generating carbon diox- 
ide; it also results from dust, dirt (including the lack of 
cleanliness of utensils) and from delay in removing waste 
or garbage of any kind, or from defective plumbing. 

Excessive moisture in air. The exhaustion and head- 
ache that so frequently result from being in badly venti- 
lated and overcrowded places are considered to be largely 
due to the combination of heat (the air exhaled being 
warmer), and excessive moisture (as moisture passes 
from the body with every breath). This prevents the 
normal evaporation from the body and therefore the heat 
and waste (that usually pass off from the body) are re- 
tained. 

The constant inhaling of impure air from badly venti- 
lated rooms undermines the constitution and leaves one 
liable to develop disease very readily when exposed to 
germs. This is the most generally recognized cause of 
disease. Fresh air is of the greatest importance as an aid 
in the development of physical health, energy and mental 
activity and in the restoration of health. The general 
health is frequently greatly improved by securing the ad- 
mittance of fresh air by day and night, or by living in the 
outside air as much as possible. 

Ventilation of room. Natural ventilation implies 
movement of the air and therefore no indoor air can be 
just the same as that of outdoors, and in ventilating a room 
this movement of air is a most important factor to con- 
sider. Have currents of air at different heights, as far as 
can be arranged. It is the constant circulation of air and 
the means of its supply and escape that form the essentials 
of good ventilation. 

In any space, the air breathed out by human beings or 
animals is at the normal temperature of the body — about 
98° — and this being warmer rises; while the colder air 



46 PRACTICAL HOME NURSING 



entering the room replaces it. Therefore in order to ven- 
tilate a room, at least one place must be provided to ad- 
mit fresh air and another (in the upper part of the room) 
to allow for the escape of impure air. This is usually 
accomplished by means of windows, doors, transoms, fire 
places or an adjoining room. A fire place aids ventila- 
tion by heating the air around it which consequently be- 
comes lighter and rises up the chimney, leaving a vacuum 
to be filled by cold, fresh air. A lamp burning in the 
grate, makes a substitute for a fire. A steady dilution of 
impure air by a constant supply of pure air is the most 
consistent way of ventilating a patient's room, and this 
must be arranged without draught in the sick room. 

Temperature of room. The average temperature of a 
patient's room should be from about 65° to 68° and a 
thermometer should be placed in the room where it will 
register the average heat, and not near the window, fire or 
light. 

Methods of ventilation. (1) One method is to open 
the window from the top only, to allow for the escape of 
air in the upper part of the room, while another current 
enters the room from between the sashes. 

(2) Open the window from the top and bottom. This 
provides three different currents of air and if necessary a 
screen * can be placed in front of the window higher than 
the lower open space to prevent draughts and to direct the 
lower current slightly upward. 

(3) If there are two windows in the room, the upper 
sash of one can be opened and the lower sash of the other. 

(4) Window board ventilation: This is a contrivance 
to assist in ventilation and consists of various methods. 

Method (1) In this case, have the window opened from 
the top and a piece of board about 10 inches deep placed 
under the lower sash. This allows air to come in between 
the sashes constantly without a direct current. 

Method (2) This consists of a frame-work of wood 
covered with wire netting and placed permanently against 



VENTILATION 



47 



the inside of the sash at the top so as not to interfere with 
the opening or shutting of the window and at the foot a 
small box arrangement about 6 to 9 inches high, fitted 
with a wire covering, placed in the same manner at the 
lower part of the window, extending across the window 
sill and not interfering with the opening and shutting of 
the window. This is an excellent way to admit air with- 
out draught. 

(5) When access to direct outside air is not feasible, 
fresh air can be admitted from an adjoining room if this 
is well aired first. 

(6) In cold weather, it is a good plan to open all the 
windows in a patient's room at the time of day when the 
air is warmed by the sun, and have the patient covered 
with extra blankets and protected by a screen. 

In hot weather, this plan is reversed and the cooler part 
of the day chosen for such purpose. An electric fan is a 
valuable aid to keep the air circulating. 

When gas or kerosene is used for lighting, or heating a 
room, more fresh air is needed, because this combustion 
uses up oxygen. For this reason, electric light is consid- 
ered best for use in a sick-room. 

Undue dryness in air. The air frequently becomes too 
dry in artificially heated rooms and causes irritation to 
the mucous membrane of mouth, throat, nose or eyes. 
Moisture should then be provided by such means as : — 
(1) Steam from a boiling kettle in the room (or in an ad- 
joining room). 

(2) An open vessel of water kept on the radiator, or 
wet cloths hung in the room. 

Note. * A practical screen can be made by fastening a 
piece of muslin or blanket to the casement of the window 
high enough to prevent a direct current when the sash is 
open. Inside shutters can also be utilized for the same 
purpose. 



48 PRACTICAL HOME NURSING 



QUESTIONS 

What is the principle of ventilation ? 
State difference between inspired and expired air. 
What effect has excessive moisture in air on health ? 
In what part of room would warmest air be found ? Why ? 
Describe different methods of ventilating a room. 
Mention practical methods of preventing draughts. 
What advantage has electricity over other forms of light- 
ing a room ? 
How may disease be caused by impure air ? 



CHAPTER VII 



BACTERIA 

Bacteria, germs, microbes, are all names used to de- 
scribe the many different forms of minute living bodies of 
plant life that are all around us in air, water, earth and 
almost everywhere. They are the smallest known form 
of vegetation and start in one cell which divides into two, 
and in this way they multiply very quickly if conditions 
are suitable for their development. Some germs later 
develop spores or seeds which have great resistant power 
and are more difficult to destroy than the germs themselves. 

Beneficial bacteria. Bacteria is so freely talked of 
in connection with disease that it is easy to forget that it 
also has a beneficial function, and is essential to Nature's 
plan for the constant interchange that is taking place be- 
tween the animal and vegetable kingdoms, keeping a bal- 
ance and preventing a waste from either, promoting the 
growth of plants and destroying dead, organic substances. 
And in fact, life itself is dependent upon these little living 
bodies. 

BACTERIA IN DISEASE 

These are called pathogenic or disease producing 
germs and they develop in animal or plant life, causing 
disease if conditions are favorable for their growth. They 
are liable to enter wherever the natural defense is weakened 
as in any susceptible part or when the general health is 
below its normal condition. Frequently the lowering of 
vitality may be attributed to overwork, lack of sufficiently 
nourishing food or fresh air. 

Preventive measures. It is most important to pre- 

49 



50 



PRACTICAL HOME NURSING 



vent in a practical way the conditions existing that are 
favorable to germ development by such preventive meas- 
ures as (1) plenty of sunlight and fresh air, (2) cleanli- 
ness of surroundings, (3) a safe disposition of refuse of all 
kinds (by burning if possible, or by the use of chemical 
agents), (4) maintaining a healthy body by personal clean- 
liness, exercise, elimination of waste from the body, suit- 
able food and sufficient fluid taken into the system, and all 
the various things that tend to keep up a normal health 
standard. 

Disease germs develop rapidly where (1) bad sanitary 
conditions exist, (2) where there is dirt, as this is a sur- 
face for bacteria to settle on, (3) where there is the com- 
bination of heat and moisture, (4) where there is bad ven- 
tilation, (5) where there is lack of good health, or lowered 
vitality, poor circulation of the blood, unhealthy teeth, lack 
of sufficient food or water, besides such germ carriers as 
dirty hands and nails, house flies, insects, vermin, etc. 

Infection. An infection is an invasion and growth in 
the body of germs that cause disease, different kinds pro- 
ducing different effects, on the substance upon which they 
feed. Each disease has its own particular germ that re- 
produces its own kind. 

Indirect infection is transmitted by air, food and 
drink. 

Direct infection is transmitted by such mediums as the 
mucous membrane of the body, the mouth (breath), cloth- 
ing, skin, etc., and is spread particularly by the discharges 
that come from that part of the body where the disease is 
located, as for example : 

The discharge from the lungs in tuberculosis, 
From the intestines when the disease is there, 
And from the mouth and nose and throat, or 
Direct discharges from the infected area as in a wound 
or a skin disease. 



BACTERIA 



51 



Infection may be spread also by being carried into other 
tissues of the body by reabsorption. 

BACTERIA IN WOUNDS 

The unbroken skin of the body is a strong guard against 
the entrance of bacteria into the system, but if the skin 
is broken the danger of infection arises at once. For that 
reason, the greatest care should be taken in the treatment 
of even a small cut or wound. The injury itself may not 
amount to much but the danger of infection does. 

Various germs enter wounds and in various ways. In 
case of accident, the germs are liable to be introduced by 
any dirt getting in at that time, or by the instrument of 
whatever kind that caused the wound, (2) if a wound is 
not kept clean, infection may develop in the wound itself, 
(3) if the cleansing fluid applied to wash out wounds, or 
the dressing used, is not in itself perfectly free from 
germs, infection can be absorbed in that manner. 

Process of wound healing. Wounds heal by forming 
new tissue which fills up the space solidly from the lowest 
part of the wound up to the surface. A clean wound is 
one in which no injurious bacteria exist. All prepara- 
tions to have things sterile are meant to prevent the en- 
trance of such germs and no detail in preparation can be 
carelessly attended to without danger of bad results. 

Treatment of wounds. To treat a cut or wound with- 
out disinfectants, let the part bleed a little first to remove 
any poison taken in at the time of the accident. Then 
cleanse with water that has been boiled and cooled and 
apply a sterile dressing as described on page 54. Apply 
this dressing wet ; or a dry dressing taken from a previ- 
ously unopened sterile gauze package may be used, being 
always careful not to handle the dressing at the part which 
will come in direct contact with the wound. Bandage this 
on and place the injured part in the most comfortable posi- 
tion for resting, as quiet to the part is essential. If anti- 



52 PRACTICAL HOME NURSING 



septics are obtainable, they may be used in place of the 
sterile water mentioned above. 

DEFINITIONS 
Sepsis means poison produced by putrefactive bacteria. 

A septic wound is an infected wound. 

Asepsis means freedom from infection. 

Sterile means free from germs. 

An aseptic wound or dressing is one free from germs, 
or sterile. 

An antiseptic is an agent by whose means the growth 
of germs is prevented (but it does not kill them). In a 
wound antiseptics prevent putrefaction by virtue of their 
action in arresting the growth of organisms or the chemi- 
cal activity of certain substances which give rise to fer- 
mentation and decomposition. They include carbolic acid, 
boracic acid, iodine, alcohol, balsam of Peru, and many 
others. 

A disinfectant is an agent which kills germs. In a 
wound disinfectants destroy germs or active chemical sub- 
stances on the surface already infected or foul. They are 
for the most part the same material as the antiseptics but 
are used in a much stronger form, as strong solution of 
carbolic acid, iodine, etc. 

Deodorant is an agent used to destroy odor. The best 
deodorant is fresh air. Chemical deodorants absorb gases 
and neutralize foul odors. Those chiefly used are char- 
coal, permanganate of potash, etc. 

STERILIZATION 

The important point in modern methods of treating a 
wound is to have preparations made beforehand in order 



BACTERIA 



53 



that all things used in such treatment may be perfectly- 
free from germs, or as it is called, sterile. 

Sterilization is a method of destroying germs with heat 
by such methods as : 

Boiling temperature 212° 

Steam pressure temperature 230° 

Dry heat 300° 

In hospitals and large sterilizing plants the heat is ar- 
ranged in large sterilizers and the dressings, instruments, 
or any articles to be rendered sterile, are left in the ster- 
ilizer at a definite heat for the required length of time. 

General disinfecting of utensils, instruments, dressings 
for wounds (cotton, gauze), fluids or lubricants, and 
clothes, is usually done by the process of sterilization, but 
chemicals are also used for this purpose. The latter, 
however, are used chiefly in strong solution for disin- 
fecting the direct discharges that contain germs, or at a 
weaker strength as antiseptics. But their use and 
strength should be governed by the physician in charge. 

Any sterile solutions of the strength required, dressings, 
gauze, cotton, instruments or utensils, are obtainable in 
sterile, sealed packages at a local drug store. 

Practical suggestions for sterilization. In house- 
holds where there are not likely to be any definite ar- 
rangements for such a purpose, sterilization may be most 
practically accomplished by first cleansing the article and 
then boiling it for the required time and using it undried 
when taken out of the water, unless there is a sterile sub- 
stance to dry it on. 

To make sterilization consistent and of any use, do not 
touch the sterilized article with the fingers, if possible to 
use a sterile instrument, such as forceps, or sterile scissors ; 
and in any case, the part to come in direct contact with the 
body must not be made unsterile by careless handling. 



54 



PRACTICAL HOME NURSING 



To sterilize a dressing. To sterilize a dressing, place 
the gauze, cotton, linen or old muslin, folded in a conveni- 
ent size, in an outside cloth and pin or tie together, and 
then boil for twenty minutes. Wring partially dry (while 
still in the outside cloth), then apply the inside dressing 
moist, taking care not to touch your own fingers to that 
part of the dressing which is to be applied to the wound. 

To sterilize towels. To sterilize towels, wrap several 
together in an outside cloth and boil twenty minutes ; wring 
out as described above and use the inside towels while they 
are wet. 

To sterilize rubber. Gloves, bags, tubings, or any 
rubber utensil, may be boiled from two to five minutes. 
These may be wrapped in a cloth and removed from the 
water without touching, or they may be boiled directly in 
the water and removed with sterile forceps, without touch- 
ing that part which will come in contact with the patient. 
Never use soda when boiling rubber as it softens it too 
much. 

To sterilize instruments. Needles, scissors, iorceps, 
nail files, etc., are sterilized by placing them in boiling 
water in which 1 per cent, of soda has been dissolved (this 
is to prevent rusting), and boil for five minutes. 

For glass utensils, tips, nozzles, etc., place them in cold 
water, bring to a boil, and boil five minutes. 

For larger utensils, place them in a large sauce pan or 
washing boiler and boil for ten minutes (active boiling). 

To sterilize gauze or cotton. To sterilize gauze or 
cotton or the stoppers of babies' bottles, place them in a 
bottle with an airtight cover, surrounding this with cold 
water, (do not let the bottle come in direct contact with 
the bottom of the pan), and bring the water to a boil. 
Keep it boiling for an hour. 



BACTERIA 



55 



Fluids, oils, or tubes of vaseline can be treated in the 
same way and thus made sterile. Water can be sterilized 
by straining or filtering it and then boiling it, taking care 
that it is kept in a sterile receptacle. 

METHODS OF DISINFECTING 
Disinfecting. Generally speaking, sterilization means 
the process of destroying germs by heat, while disinfecting 
usually implies the use of chemical agents. This latter 
method is especially used to destroy germs in direct dis- 
charges from the body. These chemicals are strong- 
poisons and should only be used by the direct orders of 
the physician. 

Stools, or movements from the intestines. Use the 
particular disinfectant in the strength ordered by the 
physician. Place as much of this as there is fecal matter 
in the vessel, stirring it thoroughly with an implement 
that can be boiled or destroyed (for instance a glass stick 
which can be easily boiled). Over this vessel place a cloth 
wrung out of the disinfectant and leave it from one to two 
hours. Then the stools can be safely disposed of in the 
usual way and the vessel rinsed and thoroughly washed 
with soap and water. 

Urine. Place equal parts of urine and disinfectant to- 
gether, leave for half an hour, and then dispose of in the 
usual way. 

Vomited matter may be treated in this same manner. 

Sputum should be disinfected when it contains germs 
from a diseased condition local to lungs, nose or throat. If 
it is possible have the patient use paper sputum cups 
and burn these intact. But if this is not practical, have 
the patient expectorate into a cup in which there is a little 
water (to prevent sputum drying and allowing the germs 
to escape into the air). At intervals of at least every six 



56 PRACTICAL HOME NURSING 



hours, mix the sputum that has collected iu the cup with 
the ordered disinfectant. Leave it for an hour, covered, 
and then dispose of it in the usual way. If cloths are 
necessary to catch the sputum, substitute if possible paper 
napkins, or use old cloths which can be burned ; otherwise 
these must be disinfected like any other receptacle, or 
boiled at once, as they contain the direct discharge. 

Clothes should be boiled as this destroys the germs. 
They are usually kept in a weak solution of chemicals 
until a convenient time to boil them. The weak solution 
of chemicals only prevents the growth of the germs tem- 
porarily, while boiling directly kills them. If there is 
any discharges on the clothes they should be boiled at 
once. 

Dishes. The simplest and surest way is to boil them 
for ten minutes. If this is not feasible, they may be left 
in the ordered solution of chemical disinfectant for half 
an hour and then washed with soap and water as usual. 
Those dishes coming in direct contact with the mouth, such 
as cup, glass, spoon, fork, etc., should be boiled. 

Hands. Scrub the nails, hand and forearm thor- 
oughly with a brush, soap and water for five minutes, then 
hold the hands in a chemical disinfectant as ordered for 
another five minutes. If no disinfectant is to be used 
after the washing, alcohol (from 50 per cent, to 70 per 
cent.) may be thoroughly rubbed into the hands. Dry 
the hands on a sterile towel, or shake them dry. 

Chemical solutions. The chemical solutions most 
commonly used for direct application to the body are: 

Salt, or saline solution, made by adding 1% teaspoon- 
fuls or 90 grains of salt in 1 quart of water and boiling. 
This is chiefly used for washing out wounds, cavities, for 
all sorts of irrigations and douches, and is not irritating 
to the surface when applied in this strength; and 



BACTERIA 



57 



Boracic acid solution, made by adding 1 part of boric 
acid powder to 24 parts of boiled water, which equals a 
solution of 4 per cent. This is used in strength varying 
from 2 per cent, to 5 per cent. It is particularly non- 
irritating and is used for eyes, nasal sprays, irrigation for 
wounds, cavities, etc. 

These two solutions while largely used on the body sur- 
face or in cavities are not strong enough to be effective as 
external disinfectants. 

Alcohol, 95 per cent., or weaker (50 per cent.-70 per 
cent.) may be used for external disinfecting of the skin or 
for disinfecting instruments or thermometers. 

Milk of lime solution (1 part of slaked lime to 4 parts 
of water) is used for disinfecting discharges. Other 
chemicals sometimes ordered by a physician are : 

Carbolic acid solution (2 per cent.-5 per cent, strength) 
— 6 drams or teaspoonfuls to 1 pint of water makes a 5 per 
cent, solution. 

Bichloride of mercury — /iooo to %ooo strength — 7/4 
grains of bichloride of mercury to 1 pint of water makes 
the strength of Mooo- 

Formalin solution — 4 per cent.-lO per cent, strength. 
This comes in a 40 per cent, solution, 1 part of formalin 
to 9 parts of water makes the strength of 4 per cent. 

DISINFECTING A ROOM 

In case it is necessary to disinfect a room after an ill- 
ness of an infectious nature, it is fumigated and the in- 
fection destroyed by the gases of the chemicals used. This 
process is also used for cleansing rooms from insects, ver- 
min, etc. 

Preparation of room. Gather such things as books, 
toys, etc., that have been used by the patient, and if there 
is a stove or grate in the room burn them. Otherwise, 
have them taken 1o a furnace and destroyed after they 
have been fumigated with the rest of the room. 



58 PRACTICAL HOME NURSING 



Open bureau drawers and closets and hang up pillows 
and blankets on a line and spread the mattress so that the 
air gets underneath it. Close windows and ventilators 
and cover fireplace. Close up all crevices around doors, 
etc., by strips of paper pasted over the openings (use simple 
flour paste which can be easily wiped off). 

Method. Have water in a large dish pan or tray near 
the floor with a protector under it. Formalin candles 
are generally used for this purpose, placing three or four 
(for an average sized room) in this dish of water, sup- 
ported on the tin stands that come with them. As there 
is no wick in them, hold a taper or candle to the edge until 
the ash begins to get white and fall away. This liberates 
the gas into the room and disinfects it. Moisture •in room 
makes it more effective. 

If sulphur is used, make the same arrangements, and 
place 4 or 5 lbs. of rock sulphur (for an average sized 
room) in a sauce pan, saturate with alcohol, and when 
this pan is placed in a larger one light the alcohol to start 
the sulphur burning. The door should be closed and se- 
curely sealed from the outside. Leave the room for twelve 
to twenty-four hours, then open the windows and thor- 
oughly air and clean the room. Sulphur fumigating is 
frequently used for destroying vermin. Sulphur will de- 
stroy roaches but not ants. 

When entering a room after it has been fumigated, to 
open the windows, hold a damp cloth to the mouth and 
nose to prevent the irritating effect of the gas on these 
parts 



BACTERIA 



59 



QUESTIONS 

Define infection. 
What is meant by sterilization '( 
How does a wound become infected ? 
How prevent such infection ? 
Describe methods of disinfecting sputum. 
Mention some of the mediums through which infection is 
spread. 

How would you sterilize rubber gloves ? 

How make a saturated solution of boracic acid ? 

How make normal saline solution ? 

In an emergency how would you cleanse and dress a cut 
hand? 



CHAPTER VIII 



THE MODEL SICK ROOM 

Beds — Changing Bedding 

TJl er normal circumstances, the average person takes 
little notice of minor details in the location and furnish- 
ing of a room. However, in time of illness the mind is 
more sensitive to uncomfortable or inharmonious sur- 
roundings and therefore the immediate environment de- 
serves the closest attention. 

The conditions described here are practically ideal and 
will be difficult, perhaps, to duplicate completely outside 
of a private hospital or sanitarium. They should, how- 
ever, be approximated, especially when the illness itself 
promises to be long or to be followed by a tedious conva- 
lescence. Some of the favorable points will be found in 
almost any room. Look for these and make the most of 
them, trying as far as you can to minimize or correct the 
unfavorable ones. 

Room. The room itself should be situated near the top 
of the house for isolation, quiet and better air, and should 
open into an adjoining room and be near a bath room. 
It is desirable to have a southern or western exposure and 
to have the room large and airy, with two windows (pro- 
tected by light and dark shades) and an open fire place. 

Floors. Hard or plain wooden floors are preferred 
covered with small, washable rugs. 

Walls. Neutral tinted or plain paper should be used, 
avoiding stripes or figures which become most irritating 
to the average invalid who finds opportunity for tracing 
monotonous designs in every line. 

60 



THE MODEL SICK ROOM 



61 



Furniture. A white enameled or brass bed (for size, 
etc., see page 63) should be placed with an open space 
around it, also a duplicate bed should be provided if 
possible; a bedside table, two small tables, a screen, a 
sofa, large comfortable chairs and two or three straight 
chairs, a hassock or foot stool, an electric reading lamp 
with shade. Growing plants and cut flowers add mate- 
rially to the " atmosphere " of a room and dainty cur- 
tains of washable material also help to make the room 
look attractive. A thermometer should be hung near the 
center of the room and some means of attachment for a 
syringe bag should be provided, such as a hook in the wall 
near the bed, or an improvised stand like a coat rack, or 
high backed chair. 

Adjoining room. The neighboring room should be 
supplied with an ice box (and ice pick), some apparatus 
for heating water, food, etc., such as a gas or electric stove 
or an alcohol lamp, in which denatured alcohol should be 
used. Guard against fire by placing whatever stove is 
used on a tray over an asbestos mat. 

Utensils. There should be at hand a large, enameled 
or granite bed pan, a small bed pan (to use as urinal), a 
douche pan, a fountain syringe bag with attachments, hot 
water bags, an ice cap, bath thermometer, clinical ther- 
mometer, two hand basins, small basins, pitchers, drinking 
glasses, small trays, glass drinking tube, spoons, 2 medi- 
cine glasses, a measuring glass, a bed tray or table and foot- 
stool. A supply of paper bags, two rubber sheets or oil- 
cloth or newspaper as substitute, soap dish with castile 
soap, two blankets for bathing purposes, an extra blanket 
or rug, pillows, back rest or substitute, a foot tub, a 
hamper, cotton, gauze, alcohol — both denatured and 95 
per cent. ; a good supply of linen should include bath 
towels, face towels, face cloths, sheets (large and smaller 
for draw sheets), pillow cases, tray cloths, napkins and 



PRACTICAL HOME NURSING 



some pieces of old linen which may be torn up as needed, 
also personal linen. 

Where there is not constant attendance, some method of 
signaling attention should be arranged for the patient, 
such as a bell or an electric buzzer. 

When there is a grate in use, avoid making dust while 
removing the ashes. When necessary, coal can be wrapped 
outside in paper and gently laid in the grate to avoid noise 
and dust. 

The bath room should be clean, tidy, and well ventilated. 

Care of cut flowers. Once in twenty-four hours, 
water should be changed on all flowers and the stems cut 
off about an inch. Flush water over the stems and re- 
place in freshly filled vases. It is wiser to remove cut 
flowers from the patient's room at night and return them, 
freshened, in the morning. 

CARE OF THE SICK ROOM 

Whoever is in attendance will be held responsible for 
the condition of the sick room and for its being clean, tidy, 
well ventilated and attractive. 

Sweeping. In cleaning a room, care should be taken 
not to raise unnecessary dust for the patient to breathe. 
Any small rugs should be removed from the room and 
brushed outside. Wood floors should be wiped over with 
a dustless mop or with a broom covered with a slightly 
damp soft cloth. Where there are carpets, a vacuum 
cleaner can be used to great advantage, as it minimizes the 
discomfort of flying dust. Also if, there are carpets or 
rugs which cannot be moved out of the room, a carpet 
sweeper — with its brush slightly dampened, may be used. 

Dusting. Use soft, clean cloths for dusting, gathering 
the dust within the cloth and not allowing it to be scat- 
tered about. Never use damp cloths on polished furni- 
ture. Protect the furniture from scratches and spots. 



THE MODEL SICK ROOM 



63 



Especially when using alcohol, care should bo taken not to 
splash or spill it as this leaves a mark on furniture. 

Glasses containing fluids should be kept on a plate or 
small tray, and when using basins, place a protector under 
them, such as paper or rubber cloth. 

Place any dressings used, or cloths on which there is a 
discharge from any part of the body in a paper bag, and 
remove and burn as soon as possible. 

All bottles should be clean and carefully labeled and 
any medicines kept in a safe place. 

The dishes and table silver used should be kept clean 
and well polished. 

All necessary appliances such as syringes, bed pans, etc., 
should be kept out of sight until needed. 



BEDS 

Of chief importance to the patient's comfort is the bed 
to be used and the way it is made. 

Kind. A white enameled iron or brass bed, strong 
enough to stand firmly on the floor, is the simplest kind 
to keep clean and the easiest to move about when necessary. 
This should be fitted with a double woven wire spring or 
the newer type of spiral spring. 

Size. The usual dimensions are 6 feet, 6 inches long 
by 36 inches wide and 26 inches high. A three-quarter 
or 45-inch bed is as wide as can be conveniently managed. 
In many circumstances a double bed is the only available 
one and when a double bed is used, the patient may be 
moved from one side to the other night and morning, thus 
providing a change and a certain amount of rest. 

Height. Twenty-six inches is a good average height 
and practically any bed can be adjusted to this height by 
raising the legs of the bed on wooden blocks. If these 
blocks are grooved or made concave, the castors will drop 



64 



PRACTICAL HOME NURSING 



into them and there stay securely. A good sized, firm 
stool or hassock is most convenient to have at hand, par- 
ticularly when the bed to be used is high. 

In cases of long illness it is imperative to have a bed 
which is, first, comfortable for the patient, and second, 
convenient for the attendant. 

Mattresses. A light-weight, hair mattress is prefera- 
ble to any other kind, being firm, elastic and comparatively 
easy to turn ; cheaper grades of felt or cotton may be used 
but are much heavier. An air mattress is used only under 
special conditions to help equalize the pressure on the body 
and to prevent bed sores. It must be partly filled with 
air and placed on top of the other mattress and should be 
at least 45 inches wide to be comfortable. It is expensive 
and made of rubber which punctures easily, and so re- 
quires careful use. A blanket should be spread between 
the air mattress and the lower sheet. 

When a hair or cotton mattress has been used for some 
time, there is a tendency for it to sag in the middle. This 
fault can be remedied by pinning, with large safety pins, 
or by sewing, a folded blanket or pad to the under side of 
the mattress under the depression. This will raise it to 
the proper level and prevent the strain that would other- 
wise be felt on the patient's back. 

Pillows. The usual, medium sized pillows are made of 
feathers covered with striped ticking. A hair pillow is 
sometimes used as a foundation pillow, while small hair 
pillows (not too full, and covered with fine ticking) are 
cool and comfortable to place around the body. These will 
be found preferable to the usual small, down pillows. Air 
pillows are of value for many purposes, particularly when 
a patient is riding or being moved in a chair, or when 
there is occasion to sit still for any length of time. 

Pillow cases. Pillow cases should preferably be of 
linen or fine cotton material. 



THE MODEL SICK ROOM 



65 



BEDDING 

Sheets. Sheets are usually made of cotton as linen 
has a tendency to chill the surface of the body. Flannel 
sheets are used in special cases. The size of sheets is 
important. They should be one yard wider and longer 
than the mattress on which they are spread to allow for 
sufficient surplus to tuck in firmly. 

Draw sheets. Draw sheets should be provided to fit 
over the center of the bed and tuck in well on each side. 
They should be from a yard to a yard and a half wider 
than the mattress. Any narrow sheet, used lengthwise 
across the center of the bed, provides a good draw sheet. 

Blankets. Blankets should be light in weight and 
color. It is better to use two or three light weight blan- 
kets than one heavy one ; as not only are they more easily 
handled and more comfortable to the patient but warmth 
may be much more readily adjusted where there are vari- 
ous layers to apply and remove. All-wool blankets are 
lighter and warmer than cotton, although in summer a 
cotton and wool mixture may be more comfortable. 

Spreads. Spreads should be of light weight material 
— a sheet makes a good substitute. 

Rubber sheets. These are made of double faced rub- 
ber sheeting, white, black or colored, and are placed to 
protect the mattress, usually between the lower and the 
draw sheet. Oilcloth or newspapers can be used as sub- 
stitutes. 

MAKING BEDS 
A closed bed. In making a bed see that it has been 
freshly aired and that the mattress is turned. A light 
pad or blanket should be provided to protect the mattress. 
Over this should be spread the under sheet, the wide hem 
to the top and a greater surplus left to tuck in at the head 
than at the foot of the bed. Tuck the sheet in first at the 
head of the bed, then at the foot of the bed and then down 
one side ; going to the other side of the bed, pull the sheet 



66 PRACTICAL HOME NURSING 



snugly across, tucking it in firmly and seeing that the cor- 
ners are neatly squared. 

All sheets and blankets must be placed with the center 
fold to the center of the bed so that they will not wrinkle 
when stretched to be made tight. 

If it is necessary to protect the mattress, a rubber sheet 
may be placed over the under sheet and tucked in at both 
sides before the draw-sheet is spread. 

The draw-sheet is tucked in firmly on one side, then 
stretched and tucked in on the other. If a double sheet is 
used for this purpose, the fold must be towards the top of 
the bed. 

The upper sheet should be placed with the wide hem at 
the top, right side down so that when the sheet is turned 
back over the bedding, the smooth side of the hem will be 
uppermost. The edge should just reach the top of the 
mattress, leaving the remainder to be tucked in at the 
foot. The lower corners should then be squared and 
tucked in. 

Each blanket is put on like the top sheet, but not nearer 
than 12 to 14 inches to the head of the bed. When the 
blankets are adjusted, the top sheet is turned back over 
them and tucked in down the sides loosely. Over all is 
laid a light spread stretched evenly to the top of the mat- 
tress and tucked in firmly at the foot, with the corners 
mitered or squared and the sides left hanging. 

Pillows should be shaken well down into their corners, 
then flattened out and placed in position ; one across the 
bed and the other standing up on it, folding any surplus 
pillow slip well out of the way. 

An opened bed — ready for use. To prepare a bed 
for a patient: (1) slip one hand under the mattress and 
raise it slightly while pulling the upper bedclothes out 
with the other. Loosen the bedding in this manner from 
both sides of the bed. (2) Fold the spread under the top 
of the blanket and then fold the upper sheet down over 



THE MODEL SICK ROOM 



67 



this. (3) Then, facing the foot of the bed, fold the 
clothes back in parallel plaits across the bed to its foot 
where they remain until needed to be drawn up over the 
patient. The pillows are arranged one on top of another. 

TO CHANGE BEDDING WITH PATIENT IN 
BED 

To replace the upper sheet only. Spread the clean 
sheet across the bed after removing all but one blanket 
and the soiled top sheet. These may be drawn away 
under the new covering and the outer bedding replaced and 
tucked snugly in at the foot and sides with the corners 
carefully squared. 

Sheets are more often changed than blankets in making 
a bed fresh so that ordinarily the spread and top blanket 
may be completely removed while the change is being 
made. 

To remove top bedding. When necessary for any 
purpose to do this, place a folded light blanket over pa- 
tient's chest, loosen the bedding at the foot and fold it 
back as far as the patient's knees; the bedding at the top 
is then turned down over this in one deep fold, drawing 
the blanket with it, then the sides one after another are 
folded over making a square. This can be readily re- 
moved and replaced, unfolding the square in the same 
manner. 

To change the under sheet. Remove the upper bed- 
clothes as described. Then, steadying the mattress with 
one hand so that the patient is not disturbed, loosen the 
under sheet and the draw-sheet. Draw or turn the patient 
to one side of the bed and fold back the soiled lower sheet 
close to the body. Then spread the clean sheet smoothly 
over the side of the mattress which is clear, leaving the 
greater length at the top and taking care that the center 
fold of the sheet is in the center of the bed. Tuck in 



68 PRACTICAL HOME NURSING 



tightly at the head and the foot, then along the side. Put 
the draw-sheet in place and tuck in on the side bringing 
the rest of it with the surplus of the lower sheet close to 
the patient's body; then go to the other side of bed and 
turn the patient away from you on to the clean sheet. 
Remove the soiled ones and spread the remainder of the 
clean sheets over the mattress, tucking them in securely 
under the remaining sides and ends. 

If a patient cannot well be turned, the knees may be 
flexed and the lower bedding drawn under the body at the 
hips, after which the shoulders and legs may be alternately 
raised while the bedding is made smooth underneath. 

To change a draw sheet. Fold the upper bedding 
back a little, loosen the soiled draw-sheet, folding it closely 
to the patient's side. Replace this with a fresh draw- 
sheet, tucking it in on the side nearest you and spreading 
the rest smoothly. Turn the patient back on this fresh 
sheet and remove the soiled one, drawing the remaining 
half of the clean sheet across the bed and tucking it in 
securely. 

The chief advantage of a draw sheet, aside from the 
protection it affords the bed, is the ease with which it can 
be changed. 

To change a draw sheet when a rubber sheet is 
used, fold, spread over the bed and tuck in both together. 

To change bedding when only one rubber sheet is 
available. Loosen bedding on one side, fold draw sheet 
close to patient's side, lay rubber sheet back up over the 
patient's body, then fold lower sheet close to patient's side 
and spread the clean under sheet. Bring down the rubber, 
lay in clean draw sheet and tuck it in, turn patient over, 
remove soiled draw sheet, lay rubber back over patient's 
body, remove soiled under sheet. Draw over and tuck in 
the clean one. Bring down rubber and spread the clean 
draw sheet and tuck them in together. 



THE MODEL SICK ROOM 



69 



In folding sheets in lengthwise plaits, as frequently 
directed, divide it into an uneven number of folds with 
the free edge topmost and nearest the side to which it is to 
be drawn. This makes quicker and smoother arranging 
possible. 

To change the mattress with a patient in bed. The 

mattress may be changed with a patient in bed by remov- 
ing the upper bed clothes, leaving just a light weight 
cover over the patient. Have two or three chairs on the 
far side of the bed on to which the mattress can be slipped. 
Draw the patient to the side farthest from the chairs and 
slip the mattress half off on to them with the patient still 
lying on it. Place three pillows on the springs for a 
temporary mattress and draw the patient back on them. 
Go to the far side of the bed, remove the sheet and turn 
the mattress over (from the head to the foot), then re- 
place it half over the wire springs. Spread a fresh under- 
sheet and draw-sheet over the mattress and tuck in on one 
side. Lift the patient back on to it, remove the pillows, 
and draw the mattress into position. Tuck in the re- 
mainder of the lower sheets and replace the upper bed- 
ding and pillows. 

To change the patient to another bed. Have a 
freshly made bed of corresponding height conveniently 
placed with the upper bedding folded back to the foot. 
Draw the patient to one side of the bed, loosen the draw- 
sheet and fold this over the patient while removing the 
upper bedding. Bring the two beds together and, going 
to the free side of the fresh bed, take the upper ends of the 
draw-sheet and the pillow (on which the head and shoul- 
ders rest) in one hand, and the lower end of the draw- 
sheet in the other, and draw the patient carefully over to 
the other bed. Draw up the upper bedding, remove the 
draw-sheet and change the pillow. 



70 



PRACTICAL HOME NURSING 



Note: This is more easily accomplished with an as- 
sistant. 

To relieve the weight of bed clothes. If there is a 
foot rail or board to the bed, the weight of the bed clothes 
may be taken from the body by being drawn over the foot 
of the bed and fastened securely either under the mat- 
tress or around the foot rail. The corners and sides 
should be folded diagonally and pinned to exclude any 
draught. If the bed lacks a foot board a high back chair 
may be used as a substitute, or a cradle which comes for 
the purpose and extends across the patient's legs beneath 
the bedding. Various substitutes may be improvised to 
keep the weight of the clothing off the body, such as a box 
with two sides knocked out. 

To prevent slipping down in bed. 1. One method 
of preventing slipping down consists in a board like a 
swing seat which may be placed upright against the feet. 
The tapes or cords at its sides are drawn tight and fastened 
to the head of the bed low down. The board should be 
deep enough to support the bedding and wide enough not 
to interfere with the moving of the patient's feet, and 
should have a small, hair pillow placed against it as a foot 
rest. 

2. A sheet folded diagonally into 12-inch plaits may be 
used similarly, bringing it below the body so that the feet 
rest in its center on a small pillow, and fastening the ends 
securely to the sides of the bed. 

8. Another method is simply to put a large pillow be- 
neath the patient's knees, or for this purpose a pillow can 
be fastened in a roll with tapes running through the center 
of the roll and these tied to the sides of the bed, thus keep- 
ing the pillow in position under the knee. 

Changing a nightdress. Gown opening in front. 

Flex the knees and draw the nightgown up and over the 
knees, and from beneath the hips, well toward the shoul- 



THE MODEL SICK ROOM 71 



der. Draw the gown out and up to the point of the 
shoulders. Slip the arm out of one sleeve, supporting the 
arm comfortably, then lay the gown over the head, put 
on the sleeve of the clean gown over the same arm, laying 
this gown also over the head. Lift the head slightly, sup- 
porting the neck, and draw both gowns from under the 
shoulders. Take hold of the soiled one by the cuff and re- 
move it. Put on the sleeve of the fresh one and draw the 
gown well down from under the shoulders ; flex the knees 
and bring it down beneath the hips and legs smoothly. 

Slip over head gown. When the gown to be removed 
is a closed one, proceed in the same manner as above. 

A gown opened in the back is very convenient and 
can be changed with little effort to the patient and this is 
the hospital model. Remove one sleeve and replace with 
sleeve of fresh gown and draw this gown across the body 
over the soiled one (this keeps the patient covered). Then 
slip off the soiled one and put on the sleeve of the fresh 
one and pull down the gown. 

Arrangement of pillows. Pillows, if well arranged, 
mean comfort to the patient, and the particular parts 
needing support in general are: — (1) head and neck, 
(2) shoulders, (3) arms and elbows, (4) small of the 
back. 

It is easier to arrange pillows both for sitting up and 
when the patient can only be partly raised with the sup- 
port of a bed-rest or substitute — a tray or board or a 
stiff hair pillow. 

In changing a pillow (one under the head) have the 
fresh one ready on the far side of the bed. Lift the pa- 
tient's head and shoulders with one arm by reaching over 
the body and remove with the other hand the used pillow, 
substituting the fresh one at the same time. Have the 
pillow come well under the shoulders. 

When two pillows are used, if the patient is lying on 



72 PRACTICAL HOME NURSING 



the back, have the first and lower one well beneath the 
shoulder blades, with the second and upper one higher on 
the bed to support the neck and head, but still under the 
shoulder blades. 

When several pillows can be used, place the largest one 
nearest the patient's back and arrange the others in over- 
lapping layers closer to the head of the bed. Slip small 
pillows under the elbows and neck and in the hollow of the 
back. 

Cage pillow. A cage pillow may be built to resemble 
an arm-chair. Some firm support such as a stiff pillow or 
a backrest should be laid against the head of the bed 
(place a towel to protect from marking bed). Shake the 
pillows well and place the two largest into an inverted V 
behind the patient's body, with the lower ends where they 
may support the elbows. Build two other pillows up on 
these in same way, bringing them closer to the body so that 
when the cage is complete the patient's back and arms will 
be completely supported. A small pillow may be added 
for the support of the neck and the head. 

Patient sitting up in bed to read. Put on a wrap 

and make a comfortable arrangement of pillows (cage or 
overlapping pillows) with a small one to support the neck. 
Place a bed-table or some substitute across the knees (not 
on them) at the most convenient height to hold the book, 
and have the light come from the back and be thrown on 
the book. 

Arrangement for sleeping when sitting up. In 

cases when a patient cannot comfortably lie down, a bed- 
table or a bed-tray covered with pillows may be laid across 
the knees and the patient bends forward and lays the head 
on it. The back should then be carefully covered and the 
arms supported with small pillows. 

For a patient who is lying on the back and can only be 
partially raised, a crow's nest is arranged with one large 



THE MODEL SICK ROOM 73 



pillow and three small ones, as follows : — Two small ones 
are crossed like an inverted V, with ends under the shoul- 
ders on top of large pillow with third pillow where they 
intersect, for the head. 

When only one pillow is available, blankets or towels 
rolled, may be substituted more or less comfortably. 

QUESTIONS 

Describe a model sick room and furnishings. 
What sort of a bed would you select % 
Describe suitable bedding. 

Describe the process of making a complete bed for patient. 
How would you change the under bedding — patient in 
bed? 

How could a patient be moved from one bed to another 
comfortably ? 

How relieve the weight of the bed clothes over the feet \ 
What methods can be used to prevent slipping down in 
bed? 

Mention the parts of the body that need particular support 
from pillow. 

How arrange a patient comfortably to sit up in bed and 
read \ 



CHAPTER IX 



MOVING AND LIFTING A PATIENT 

Purposes. To relieve pressure and thus keep circula- 
tion active. 

To rest the muscles by changing the position. 
To place the patient in a convenient position. 

Suggestions for simplifying moving. Move the pa- 
tient with a firm steady motion, using the level of the 
entire hand and not merely the fingers. 

Have the weight evenly distributed and move the hands 
simultaneously. 

In order to make an easier move, draw the patient to- 
wards you, rather than push her from you. 

In moving, supporting or turning a patient, place the 
hands under the bony parts of the frame, i.e., the shoul- 
ders and the hips; otherwise the patient is made uncom- 
fortable and a less firm purchase is to be had on the body. 

When raising the center of the body for any reason, 
have the patient flex the knees (or do this for her). In 
this position the patient has much more power to raise her 
body to assist you, or if too weak to do this, the hips are 
still raised to some extent (by this position of the legs). 

Always support the patient's neck in the hollow of your 
arm, when moving the shoulders and head. 

When a second person assists, the weight should be 
evenly distributed between the two, and the movements of 
both should be simultaneous. 

74 



MOVING AND LIFTING A PATIENT 75 



To move a patient up in bed. Patients are very apt 
to slip down in bed too far, and need assistance in being 
drawn back on the pillows. 

Method. Flex the patient's knees. Slip one arm 
under the neck, and support the far shoulder blade with 
the hand, the lingers reaching the hollow under the arm, 
and the neck resting on the curve of your arm. Place 
your other hand well under the hips, and draw the patient 
up in bed by moving both arms together. If possible 
while doing this, have the patient press on her heels to 
assist. 

To move a patient down in bed place the hands in the 
same position, flex the knees and simply move the body 
toward the foot of the bed. 

To draw patient from one side of the bed to the 
other. Place one arm under the shoulders as previously 
described, with the other arm well across, and under the 
hips. Draw the patient steadily toward you, moving both 
arms at the same time. If the patient is too heavy to 
move all at once in this way, use both hands in moving 
each part, first the shoulders, then the hips, then the legs. 

If assistance can be obtained, distribute the patient's 
weight (after her knees have been flexed, as usual) upon 
the four hands, placed well under the trunk, and move 
them together. 

To turn a patient on side. Slip your hands under the 
patient's shoulders and hips and turn her on the side, at 
the same time drawing the hips and shoulder back slightly. 
Thus the weight falls directly on the side, relieving all 
strain on the back. It is sometimes comfortable to flex 
the upper knee and place a pillow beneath it for support. 

To help a patient to a sitting position in bed. Place 



76 PRACTICAL HOME NURSING 



your arm under the neck and shoulder. Your other arm 
is inserted under the patient's back from the other side, 
reaching over the body to do so. Draw up the patient to 
a sitting position. 

To draw a patient who is sitting up in bed further 
back towards the pillows. First flex the patient's knees. 
Then, standing behind her, place both your hands beneath 
the buttocks and draw the hands back together. 

To lift a patient from bed. If two persons are to lift 
a patient out of bed, they should both stand on the same 
side. One of them places her hands under the neck and 
shoulders (supporting the head) and the other hand in the 
middle- of the back while the other helper's hands are 
placed under the hips and just below the knees. Draw 
the patient to the edge of the bed, then lift, taking care to 
make all movements at the same time. 

With a heavy person a third helper is necessary. The 
weight should be distributed by four hands under the 
trunk, and two under the legs. 

To carry a patient in a sitting position. Draw the 
patient to a sitting position in bed, and turn her around 
with her back close to the edge of the bed. Have the at- 
tendants form a chair with their hands and slip them 
under the body, having the patient sit on the seat thus 
provided, and support herself by placing her arms across 
their backs with her hands touching the far shoulders. An 
assistant is necessary and the " chair " is made by having 
each person grasp her own left wrist with her right hand, 
then each takes the other's right wrist. 

To get a patient up in a chair. Articles required : 
Chair Blanket or rug Wrapper Stockings 

Pillows Foot stool Personal Slippers 

clothing 



MOVING AND LIFTING A PATIENT 77 



Method. Place the chair close to the bed and arrange 
one end of the blanket on it so that it can be used to cover 
the legs and feet. Turn the bedding slightly back from 
the side of the bed and draw on the stockings. Put on 
the far arm of the dressing gown first, and draw it down 
over the body, while removing the bed clothes beneath it. 
Then with one arm beneath the patient's shoulders and 
the other under the knees, draw your arms together, and 
turn her to the edge of the bed, thus swinging the patient 
to a sitting position. This is known as " pivoting " and 
is usually quite easily done. With the patient sitting on 
the edge of the bed, put on the other sleeve of the gown 
and the slippers. Then, standing in front of the patient, 
pull the gown down, put your hands under her arms and 
with the patient's hands on your shoulders assist her to 
the chair ; then wrap the blanket well around her legs and 
arrange the pillows comfortably and if the chair can be 
moved (on casters) take it to another part of the room or 
to an adjoining room, thus providing a change of scene, 
which rests the mind. Place a footstool under the feet 
or provide some sort of support as a substitute. It is ad- 
visable to take the pulse at intervals after the exertion of 
getting up. If there are symptoms of faintness at first, 
a drink of cold water and fanning will usually give relief. 
If actually faint, the head may be brought forward and 
down. Care should be taken not to overtire a patient 
especially when first sitting up. 

While the patient is out of bed turn the mattress and 
remake the bed, leaving it with the upper bedding folded 
back to the foot. 

To help a patient back to bed. Draw the chair close 
to the bed, then, standing directly before the patient, place 
your hands under her arms and with her hands on your 
shoulder assist her to a sitting position on the edge of the 
bed, first lifting the skirt of the gown. Remove the 
sleeve from the far arm and draw the gown away from the 



78 PRACTICAL HOME NURSING 



back. Place your arms under the shoulders and knees, as 
described before, and bring them together, and pivot the 
patient back into bed. Remember to have her placed, 
when on the edge of the bed, near enough to the pillows so 
that when pivoted around the head and shoulders will rest 
on them without extra moving. Remove the dressing 
gown, slippers and stockings, replace bedding and let the 
patient rest. 

To move an extremity. It is frequently necessary 
to move a painful or sore leg or arm for various reasons, 
or to elevate it (elevating a part eases the pain where there 
is inflammation). 

For an arm. Support the elbow with one hand under 
it and place the other under the wrist and move both 
hands together. 

For a leg. Place one hand under the knee and with 
the other support the ankle and move the leg steadily and 
gently. 

QUESTIONS 

State points to consider for patient's comfort when mov- 
ing patient. 

State points to consider for your own ease when moving 
patient. 

How would you assist a patient to get out of bed ? 
How arrange comfortably on chair sitting up ? 
Describe method of moving an injured arm — leg. 
How would you move a heavy patient from one side of 

bed to the other ? 
Describe method of turning a patient to lie on her side. 



CHAPTER X 



BATHS 

The matter of personal cleanliness is at all times impor- 
tant in order to maintain general good health and comfort 
and in time of illness this needs especial attention, not 
alone to keep the skin in good condition but also to alleviate 
various internal irregularities. 

The skin. The skin is furnished with many small 
glands, ducts and pores, and in some places these are more 
numerous, as under the arms, at the soles of the feet, 
etc. The sebaceous glands supply an oily substance which 
keeps the skin soft. 

Perspiration. The sweat glands separate the per- 
spiration from the blood and this is passed out through 
the pores or ducts. The average amount is about two 
pints daily but this varies, influenced by such conditions 
as outside temperature, exercise, etc. This perspiration 
represents a form of waste that is being constantly elimi- 
nated from the system and as all waste matter decomposes 
rapidly, once outside the body, unless this is removed, the 
odor becomes offensive and in time of illness this is even 
more apparent. Perspiration also helps to regulate the 
temperature of the body. The constant evaporation of 
this fluid prevents the heat from accumulating, as for in- 
stance — a person while exercising accumulates heat, the 
skin at the same time throws off more perspiration — and 
the temperature of the body is kept even. 

Bathing. Baths are given for various effects and at 

different temperatures, but the fundamental reason is to 

stimulate the action of the skin, so that it can perform its 

79 



80 



PRACTICAL HOME NURSING 



various functions. By bathing — the blood circula- 
tion of the skin is stimulated — the temperature of the 
body is kept even — and the residue of the oily substance, 
with the waste matter which is brought to the surface by 
perspiration is removed. In most conditions a bath is 
refreshing to the patient and soothing to the nerves. 

Temperatures of baths. 

Hot bath 105-110° 

•Warm bath 90-100° 

Tepid bath 80- 90° 

Cool bath 70- 80° 

Cold bath 60- 70° 



Cool or cold baths are given for their tonic effect and 
also to reduce temperature. A patient should be rubbed 
constantly during such a bath to bring more blood to the 
surface to have it cooled. 

Hot baths are sometimes ordered for special reasons 
to cause excessive action of the skin, to relax muscles or to 
stimulate the heat of the body. Hot baths taken continu- 
ally are enervating. 

A warm bath with a non-irritating soap is the usual 
bath for cleansing purposes. This sometimes may be 
followed by a cold sponge to act as a tonic for the skin. 

Soda, bran and starch baths are used to allay irritation 
of the skin and are given warm or tepid. 

A soda bath is prepared in the proportion of 8 ounces 
of bicarbonate of soda (ordinary baking soda) to every 
gallon of water. In this case the patient should be care- 
fully dried without rubbing to avoid irritating the skin. 

A bran bath is prepared an hour beforehand by plac- 
ing two pounds of bran in a bag (cheesecloth or some 
other thin material) and allowing it to soak in a tub half 
full of water, and squeezing the bag often. Hot water 
may be added immediately before the bath. 



BATHS 



81 



A starch bath is prepared thus : — mix about 8 ounces 
of starch in a little cold water. Add sufficient boiling 
water to make a very thin paste and mix this with the bath 
water. 

Salt baths are given for their tonic effect on the skin. 
Allow 2 or 3 pounds of salt to a tub half full of water, dis- 
solved in hot water and then cooled to the desired tempera- 
ture, which is usually cool or cold, although sometimes or- 
dered quite warm. 

Odor to perspiration. If the odor of perspiration is 
very strong, even if care to bathe has been taken, this can 
be lessened by using bicarbonate of soda or ammonia, 1 
teaspoonful to a quart of water, and washing the parts 
where the glands are thickest in order to counteract the 
acidity in the perspiration which, in such cases, largely 
causes the odor. 

Dry skin. If the skin is unduly dry, rub in some lubri- 
cant such as cocoa butter, oil, or cold cream after the usual 
bathing. 

Moist skin. If the skin is unusually moist, alcohol 
(95 per cent.) should be rubbed on after the bathing, and 
the skin powdered with talcum. 

Excessive moisture or " night sweat." Sometimes 
due to sudden fall of temperature or extreme weakness 
the skin perspires too freely, and excessive perspiration or 
" night sweat " is the result. Care must be taken to pre- 
vent a patient taking cold as the vitality is lowered under 
these circumstances. 

Method of treatment. Pin a blanket around pa- 
tient's neck and keep this over the body while removing 
the wet clothes. Then rub the skin dry with hot towels 
and apply warm alcohol (warmed by placing the bottle of 
alcohol in hot water). Put on warm, dry clothing and 
bedding. 



82 PRACTICAL HOME NURSING 



GENERAL RULES FOR BATHING 

The ideal times for bathing are in the morning or at 
night. 

Baths should not be given sooner than 1% to 2 hours 
after eating as, by thus increasing the circulation of the 
skin, blood is brought from the stomach where it is needed 
during the process of digesting the food. 

The room in which a bath is taken should be warmer 
than usual and without draughts. 

Everything needed should be ready before beginning the 
bath. 

TUB BATH 

Uses. 

For cleanliness 
To increase temperature 
To decrease temperature 
To relax the muscles 
To soothe the nerves 

Articles needed. 

Chair Soap Wash cloths 

Bath mat 1 face towel Personal linen 

2 towels, warmed 

Method. The room should be warm and without 
draughts. Place a chair conveniently near with a towel 
spread on it and a mat on the floor beside the tub. Fill 
the tub half full of water at a temperature of 90° or, if 
desired, the bath can be made warmer. Help the patient 
both in getting in and out of the tub. Use plenty of 
castile soap and a rough wash cloth. Rinse the skin well 
and when drying, rub briskly with a warmed towel to in- 
crease the circulation. Have the patient rest for at least 
an hour afterwards. 

Note. When a patient is taking her own bath, always 
stay within call in case your assistance is needed. 



BATHS 



83 



SPONGE BATH IN BED 

Uses. 

For cleanliness. 

To keep the pores of the skin open. 
To give comfort to patient. 

To remove waste material given off through the skin. 

Articles needed. 

2 basins Small blankets 

1 face towel Soap 

2 bath towels Alcohol 
2 wash cloths Powder 

Personal and bed linen 

Method. Half fill one basin with water at a tempera- 
ture of 110° and the other with cooler water for rinsing. 

Draw patient toward the edge of the bed. Remove the 
pillow entirely (to rest the muscles of the neck) or replace 
it with a smaller pillow if the patient prefers. 

Lay a small blanket, arranged in three folds, across the 
chest and have the upper end of it held by the patient or 
tucked in around the shoulders so that while folding down 
the bedclothes to the foot of the bed, the other end of the 
blanket may be drawn with it, thus covering the patient. 
Then place another small blanket lengthwise on the bed, 
rolled close to the patient's side. Draw this beneath the 
body and remove the nightdress under cover. 

Each part is washed, rinsed and dried separately and the 
body is at all times protected by a cover blanket. 

In using a wash cloth, take all four corners within the 
hand to prevent them dripping on the patient, and wash 
with firm, gentle stroke. First bathe the face, wiping the 
eyes toward the nose. Then the neck and ears. Then 
bathe the arms and immerse the hands in the water and 
carefully clean them, using a brush and an orange stick 
for the nails, and when bathed wrap the arms in folds of 



84 PRACTICAL HOME NURSING 



the under blanket. Then proceed to bathe the chest, axil- 
lae and abdomen. After drying them, turn the patient on 
the side and wash to the waist line, then to the middle of 
the thigh, and dry. Turn the patient again on the back 
and wash the legs, which can more easily be done by flexing 
the knees. Place the feet in the basin of water when 
bathing them and use a brush for the nails. Wash the 
soles of the feet with firm, steady strokes to prevent tick- 
ling and carefully bathe the pubic region unless this has 
been done prior to the whole bath. 

If alcohol is used, rub it on each part after it is dried. 
Powder if desired. 

When the bath is finished, remove the under blanket, re- 
place the nightdress, draw up the bed clothes, and remove 
the cover blankets. Replace the pillows which have been 
shaken up and if the bedding requires to be changed, this 
should be done at the same time that the under blanket is 
removed. 

In case only one bath blanket can be procured, use it 
doubled or substitute turkish towels. 

COLD ALCOHOL SPONGE BATH 

Uses. To reduce temperature. 

Articles needed. 

1 basin of cold water 1 hot water bag 

2 large wash cloths of rough 3 safety pins 

material 1 bottle alcohol, 95 per cent. 

3 towels Ice bag or cloth for head 

Ice (if ordered) 
Mix alcohol and water in equal parts. 

Method. Prepare the bedding and the patient as for a 
sponge bath, except for these details : a rubber sheet should 
be put beneath the under blanket so that more water may 
be safely used, and a loin cloth is pinned about the hips. 
Allow the head to remain slightly raised. 



BATHS 



85 



Apply an ice bag to the head, or a cloth wrung out of 
cold water and frequently changed. Then remove the 
upper blanket. Proceed to bathe the large surfaces of the 
body, keeping up friction which, by constant rubbing, 
brings the blood to the surface of the body to be cooled. 
Let the water evaporate ; do not dry it off. The only part 
which cannot be vigorously rubbed is the abdomen or any 
tender spot. 

Half the time ordered for the bath (usually 15 or 20 
minutes) is given to sponging the front of the body; the 
remainder is spent on the back with the patient turned on 
her side. 

To remove the patient from the bath. Eemove the 
cold application from the head. Place a blanket over the 
body and remove loin cloth and under blanket by rolling 
them close to the patient's side and slip another blanket in 
their place at the same time. Turn the patient on to it. 
Draw up the upper bedding and place a hot water bag 
near the feet. Give hot broth to drink and at the end of 
half an hour remove the blankets and hot water bag, re- 
place the nightgown and take the temperature, pulse and 
respiration. 

FOOT BATH 
Uses — in general. 

To relieve congestion, by increasing general circula- 
tion. 

To draw blood away from the head. 

Articles needed. 

Foot tub and water Pitcher with additional hot 
1 rubber sheet water 
3 towels Hot water bag with cover 

1 blanket Bath thermometer 

Mustard 

Foot bath for patient in sitting position. Patient 

should recline in a comfortable chair. The bath is pre- 



86 PRACTICAL HOME NURSING 

pared in a foot tub at a temperature of 105°. Place 
the rubber sheet on the floor to protect the rug ; fold the 
blanket in half, placing one end under the knees so that 
the patient is sitting on it. Then move the tub in posi- 
tion, having a thermometer in the water or testing heat 
with jour elbow. Lower the feet gently into the water 
and cover with the other end of the blanket, lifting one 
corner occasionally to add hot water. This should be done 
gradually until the temperature reaches 110°. When 
mustard is added (one tablespoonful to a gallon of water) 
a lubricant should be applied to the soles of the feet to 
prevent irritation. 

When finished, withdraw the tub, dry the feet and leave 
them wrapped in a blanket or apply a hot water bag for 
a few minutes. 

Note. Mustard should be mixed to a thin paste in cold 
water and thoroughly stirred into the bath. 

Foot bath in bed. Flex the patient's knees and turn 
the bed clothes back from the foot of the bed over them; 
lay the extra blanket into a simple envelope or fold, one 
side of which rests on the bed under the tub while the 
other is drawn up over the legs and tub. Continue the 
bath as described above. It will be found more conveni- 
ent to let the tub lie lengthwise on the bed, with the edge8 
covered by a folded towel to protect the legs from touching 
the edge. 

WASHING THE HAIR IN BED 
Articles needed. 

1 rubber sheet 1 pail 

2 bath towels 1 pitcher hot water 

3 towels 1 pitcher cold water 
Comb and brush Castile soap 



Method. Make an improvised Kelly pad by rolling a 
large bath towel firmly and placing it in a half circle at 



BATHS 



87 



the right hand corner at the head of the bed, leaving the 
open part of the circle toward the outside of the bed. Over 
this place one end of the rubber sheet and tuck in the cor- 
ners under the rolled towel. This forms a depression into 
which the patient's head may be placed. Put the other 
end of the rubber sheet in a pail on the floor and fold in 
the sides to form a trough or tube so that the water used 
in washing the hair will be directed downward into the 
pail. 

Make a good lather of soap and wash the hair, rinsing it 
in warm water thoroughly two or three times. Lift the 
head out of the Kelly pad on to a bath towel and dry with 
extra towels. Apply 95 per cent, alcohol to the hair to 
assist in drying and rub until thoroughly dry. Separate 
the hair into several strands with the fingers and brush each 
one free of tangles. 

Pediculi or lice cause an eruption on the scalp accom- 
panied by constant itching. 

Treatment. Saturate the hair with kerosene oil and 
bind the head in a cloth for two hours. Then wash the 
hair in warm vinegar to soften the eggs or nits, and comb 
with a fine comb. After this wash the hair with warm 
water and soap. 

Larkspur may be used instead of kerosene and followed 
by the warm vinegar as described above. 

If any nits or eggs are left on the hair, apply warm vine- 
gar and comb with a fine tooth comb. 

Note. If kerosene oil has been used, precaution must 
be taken to keep the head away from lighted gas or any 
open flame until it has been washed off. 

Arranging a patient's hair. Method. To comb a 
patient's hair in bed, draw her as near the edge of the bed 
as possible. Provide some covering for the pillow. 
Comb very gently, beginning at the end and always hold- 
ing the hand between the comb and scalp to prevent pull- 
ing. If the hair is badly tangled it may be made some- 



88 PRACTICAL HOME NURSING 



what easier to comb by rubbing in a little vaseline or alco- 
hol at the tangled part. Part the hair and arrange in two 
braids. If the patient can sit up even for a short time, the 
hair should be left until then to arrange. 

The scalp needs to be rubbed frequently and a little 
lubricant applied. 

CARE OF THE MOUTH 
The mouth requires close attention and care during ill- 
ness as any infection from an unclean mouth can easily 
affect the mucous membrane all down the alimentary 
canal. 

Infection can also be carried from the mouth to the ear 
through the eustachian tube. 

A patient suffers great discomfort from an unclean or 
sore mouth or tongue, also from an unhealthy condition of 
the teeth. The latter frequently causes a sore mouth and 
many unfavorable conditions in the body. 

Methods of caring for the mouth. Brush the teeth 
night and morning and after every meal with a fairly 
stiff toothbrush, being sure that the back of the teeth also 
are brushed, using toothpaste or an antiseptic solution, 
such as listerine or borine, as preferable to powder. 

In case of extreme sensitiveness of the mouth or where 
difficult to open wide, procure a soft, small toothbrush for 
this purpose, or wrap cotton on a stick or on a piece of 
whalebone and dip this in an antiseptic solution and then 
rub the cotton very gently over the gums and teeth. 

When a patient cannot sit up turn the head a little to 
one side and have them use a flat basin or an ordinary 
soapdish to expectorate in. The mouth should be rinsed 
out after food. 

To clean the tongue. Take a small wooden stick or 
whalebone with the end wrapped in cotton and dipped in 
the solution and wash off the tongue with it. If the 
tongue is dry and hard apply a lubricant such as : 



BATHS 



89 



J 2 parts glycerine 
1 1 part lemon juice 

2. Glycophosphates 

g J 1 part alboline 
[ 1 part lemon juice 

Any of these can be applied with a dropper or a wooden 
toothpick with cotton on the end is convenient. 

When the patient is on a milk diet, the mouth should be 
rinsed out after each feeding with a weak solution of bi- 
carbonate of soda, 1 teaspoonful to a glass of water (few 
drops of tincture of myrrh may be added). 

If the patient wears false teeth, these must be carefully 
cleaned and kept in water when not in the mouth. 

A little lubricant or oil sprayed or rubbed inside the 
nostrils is a simple way of giving relief when they are 
dry, or breathing through the nose is difficult. 

CARE OF THE HANDS 
The hands become uncomfortable unless well cared for 
in the time of sickness. They need frequent washing, 
especially before and after eating, and if the skin is dry 
rub on cold cream or almond cream lotion. Keep the nails 
filed short and soft with a lubricant, and use an orange 
stick for cleaning them. The cuticle can be rubbed back 
with a towel when drying the hands each time. 

CARE OF THE FEET 
To keep the feet in good condition have them soaked 
in warm water at least three times a week, and washed 
daily. Some oil, vaseline, or other lubricant can be 
rubbed in if the skin and nails are dry and hard. The 
nails should be cut straight across, not curved, and where 
there is a tendency toward ingrowing nails clip an inverted 
disc in the center and scrape the center surface as thin as 
possible to draw the nail away from the sides. If the feet 



90 PRACTICAL HOME NURSING 



perspire too freely, they become tender, sore and chafed, 
and there is likelihood of a strong odor. To overcome this 
tendency bathe daily with soap and water and then with 
salt and water and rub with alcohol and powder. Change 
stockings frequently and let air get to the inside of the 
shoes. 

PUBBING A PATIENT 

There are innumerable times in sickness when rubbing 
is needed and if well done gives a great deal of comfort 
to the average patient. Regular massage is the science of 
exercising the muscles and requires very exact knowledge 
and should not be confused with ordinary rubbing : — this 
rubbing increases the circulation under the skin and soothes 
the nerves by relieving the tension and tends to keep the 
whole skin healthy, particularly when normal exercise is 
restricted as with the sick. 

In order to make a smooth motion, use even pressure of 
the whole hand and don't press in with the fingers and 
have a little lubricant or powder on hand. 

In the extremities, follow the course of the veins, rub- 
bing toward the heart and from the head down. For the 
forehead rub over the eyes, using the tips of the fingers 
lightly and press outward. 

For the arm, hold the wrist in one hand and rub up 
with the other. 

When rubbing the lower extremity stand facing the 
foot of the bed and draw the strokes toward you (this gives 
your arm freer action). The abdomen is sometimes 
rubbed when patient is constipated and the direction 
should be up the right side, across the top and down the 
left side. 

To rub the back, have the patient turned toward you 
and rub out from either side of the spine and for the 
shoulders and lower part of the back rub with circular 
motions, making the skin move under your hand. The 
back requires frequent rubbing. 



BATHS 



91 



PREPARING A PATIENT FOR BREAKFAST 

A sick person is usually in no condition in the early 
morning to endure exertion, so that the few preparations 
necessary before breakfast should be made with as little 
effort to the patient as possible. 

Take the temperature, if necessary ; the face and hands 
should be washed and the .hair smoothed, not arranged, 
the teeth cleaned and the mouth rinsed out. Straighten 
the bed clothing and have the room tidy. If able to sit up 
in bed, place a wrap around the patient's shoulders and a 
large pillow or bed rest directly against the head of the 
bed for her to lean against, and small pillows arranged 
where needed and a stand or table for the tray. 

Breakfast itself should be a light meal and attractively 
served, to tempt the appetite. 

TO GET A PATIENT READY FOR THE NIGHT 

If possible let a patient sit up in a chair for a few min- 
utes before retiring. Tighten and smooth the under bed- 
clothes and brush out any crumbs. See that the upper 
bedding is sufficiently loose to be comfortable over the feet 
and is drawn up high enough to cover the shoulders when 
the patient is lying down, and have fresh, cool pillows. 

Give any necessary nourishment, wash the face, hands 
and teeth, and brush the hair. Rub the back with alcohol 
and powder it. Change the nightdress, and if necessary 
for comfort, a small pillow may be placed under the back, 
or, if the patient lies on the side, under the abdomen, to 
give support. Sometimes a warm bath is given or an 
alcohol rub. Darken the room and see to it that there can 
be no noise from rattling windows or banging doors. 
(Wedges put in windows and doors, or a cloth tied from 
the door handle inside to another outside helps to prevent 
these sounds.) Leave an extra cover at hand for the 
patient to draw over her toward morning if she should 
feel cold. Open the windows and use a screen if neces- 



92 PRACTICAL HOME NURSING 



sary to prevent draughts or streaks of light from outside. 

Giving a bedpan. Warm the bedpan first, then turn 
the bedclothes slightly back. Have the patient flex the 
knees. Raise the hips, draw up the gown and insert the 
pan at right angles to the bed, turning it so that it lies in 
proper position under the patient. If the patient cannot 
raise the hips, have pan in position, flex the knees and with 
both your hands raise the hips; hold with one hand and 
insert the pan with the other. 

Removing bedpan. Flex the patient's knees, raise the 
hips, and withdraw the pan in same manner as it was in- 
serted. Cover and remove. Turn patient on the side and 
wash off the part. 

To prevent bedsores and for the comfort of the patient 
it is very necessary to raise the hips perfectly clear of the 
pan while inserting or removing. If a patient is emaci- 
ated, it will be more comfortable to place a rubber ring 
partly inflated with air over the bedpan before inserting. 
A small pillow or a folded towel should be placed under 
the small of the back with the end over the edge of the 
pan. 

QUESTIONS 

What different purposes are tub baths given for ? 
Mention points to be considered in giving them. 
Describe method of giving sponge bath for cleanliness. 
Mention points of difference when giving sponge bath to 
reduce fever. 

Under what circumstances would soda or bran baths be 

advised ? 

Describe the method of giving a mustard foot bath. 

What results are expected from it ? 

What are the dangers of an unclean mouth ? 

How can they be avoided % 

What effect has rubbing on the skin ? 

In what direction are the extremities rubbed ? 



CHAPTER XI 



BED SOKES 

Pressure sores are usually spoken of as bed sores, al- 
though they can develop under any condition where there 
is a constant pressure on a part, as this prevents healthy 
circulation. 

This pressure may come: (1) from the body being con- 
stantly in one position; (2) from one part pressing against 
another; (3) from moisture and unclean] mess of the 
skin; (4) from friction from the bed clothes or (5) from 
splints and bandages improperly adjusted. Paralytics 
and very thin or emaciated patients or those with other- 
wise lowered vitality are especially susceptible to this 
danger. 

The most susceptible parts are the lower end of the 
spine, the buttocks, hips, heels, knees, ankles, toes, elbows 
and ears. When placing or removing a bed pan special 
care should be taken to raise the hips sufficiently to avoid 
rubbing the surface against the pan. 

Prevention of pressure sores. Bathing and rub- 
bing. Bathe the parts frequently. Keep the skin dry 
and stimulate it by rubbing, using a little lubricant on the 
hand and rubbing with a smooth firm touch in circular 
motions. This is always to be followed by rubbing with 
alcohol which leaves the skin dry, hardened, and less liable 
to break down. Then apply talcum or stereate of zinc 
powder. 

Remove pressure. If a patient can be turned, change 
the position frequently as the simplest way to remove pres- 
sure. If this cannot be done, the pressure must be kept 

93 



94 PRACTICAL HOME NURSING 



away from the susceptible parts by the use of rubber or 
cotton rings, air pillows, or an air mattress. 

For the lower part of the back, a rubber ring is neces- 
sary. This should be covered with a bandage or should 
be slipped into a pillow case. This ring should be only 
partly inflated, otherwise it will be hard, uncomfortable, 
and may itself cause irritating pressure. In case of a 
very heavy patient, two such rings can be used, one on top 
of the other, both only partly inflated and tied together by 
a bandage or adhesive plaster. Be sure that the part to 
be protected does not touch the surface under the ring. 
To ease the consequent strain on the muscles, place a pillow 
in the hollow of the back. Rings made of cotton and 
covered with bandage, or air pillows, can be utilized to 
keep pressure off various parts of the body. A hot water 
bag partly filled with air makes a good substitute for 
such a pillow. 

Signs of development of bed sores. If a patient 
complains of stinging when rubbed with alcohol, stop the 
use of alcohol at once as this sensation indicates that the 
skin is nearly broken. Apply stereate of zinc powder or 
oxide of zinc ointment over the part. Remove all pres- 
sure and rub around the part towards the wound and not 
away from it. This will improve the general circulation 
at that part. 

Always notice the least sign of redness of the skin. 

Bed sore wound. Report the first sign of a bedsore 
to the physician. When a sore has formed follow orders 
as to dressing, etc. It would be treated as any wound, but 
particular care must be given to those developing around 
the hips and buttocks in order to prevent fecal matter or 
urine from infecting them. Remove all pressure. 

If the skin is reddened or sore from pressure from 
splints or bandages these must be readjusted and the skin 
rubbed with alcohol and alum (to harden it) and well 
powdered. 



BED SORES 



95 



A patient who is constantly sitting in a chair requires 
care to prevent pressure sores, liubber rings and air or 
soft hair pillows can be adjusted to relieve such pressure, 
and the arms of the patient must also be protected in many 
cases by the same method. Patients suffering from any 
form of paralysis are very susceptible to this danger. 

When an invalid is driving or motoring. It is a 
comfort to an invalid when driving or motoring to have 
an air cushion under the body to ease the strain. 

QUESTIONS 

What may cause bed sores ? 

What practical means can be taken to prevent them ? 
Mention the parts of the body most susceptible to bed 
sores. 

Describe the practical methods for removing pressure. 
How may a threatened sore be prevented from developing ? 
Why are bed sores difficult wounds to heal ? 



CHAPTER XII 



EN EM AT A 

An enema is an injection of some fluid into the intes- 
tines through the rectum. 

Kinds. 

/ Simple laxative . To stimulate the muscular action of 
(.Laxative the intestine 

Nutritive To give nourishment 

Stimulating ... .To give stimulation 

Saline irrigation . To supply fluid to the system and to 
cleanse the intestines 

Under normal conditions an individual should have at 
least one movement a day from the intestines, otherwise 
there is a reabsorption of this waste into the system which 
acts as a slow poison causing various disturbances. This 
is usually regulated by exercise and the proper diet. In 
time of illness the lack of exercise and the more con- 
densed food taken are apt to make the use of an enema 
necessary. 

GENERAL RULES FOR GIVING AN ENEMA 

All appliances must be absolutely clean before using, 
and thoroughly cleansed afterwards by washing with soap 
and water, rinsing and drying. 

All tubes, tips or nozzles must be sterilized by boiling, 
rubber tubes being left not longer than two minutes in the 
water. 

Always let the fluid run to the end of the tube to expel 
the air, then clamp until inserted. Leave fluid in the 
tube and clamp it before withdrawing for the same reason. 

A screw may be fastened in the wall near the bed at the 

96 



ENEMATA 97 

desired height to support a fountain syringe bag. This 
will be filled with whatever solution is required for the 
treatment. The force of the flow is regulated by the 
height of the bag. 

Appliances used. 

Rubber sheet Fountain syringe or irrigat- 

Cotton sheet ing can, with tubing, 

Towel clamp, and nozzle 
Bed pan or commode Soft rubber rectal tube 

Lubricant Proper quantity of solution 

Glass funnel to be used 

The tubing attached to the syringe or irrigator is usually 
about five feet long, fitted with a clamp to control the flow, 
and is connected with a soft rubber rectal tube by a glass 
connecting tube. 

Position. The patient should be placed on the left 
side. This allows the fluid to go higher into the intestines, 
because it can follow the natural course of the canal. The 
next best position is to have the patient on the back. The 
knees should be drawn up to relax the muscles of the 
abdomen. 

SIMPLE ENEMA 
Preparations. Place a rubber covered by a sheet under 
the patient, at the same time drawing up the nightdress to 
the waist line. Turn the patient on the left side, bending 
the knees. Arrange the bed clothes conveniently and 
place a towel over the rectum. 

Solution used. A solution of warm water and castile 
soap (which is non-irritating), 1-3 pints for an adult 
or 14 to 1 pint for a child, is most commonly used. The 
suds should be removed. 



Process. Have the solution in the bag at a temperature 



98 



PRACTICAL HOME NURSING 



of 105° and hang it two feet above the patient. Lubricate 
the rectal tube, expel the air from the tube, clamp it and 
insert gently into the rectum. For a high enema, the 
tube is inserted about 8 inches ; for a low one, 3-6 inches. 
It is easier to retain a high enema than one just inside the 
rectum. If there is any difficulty in inserting the tube, 
do not force it, but withdraw it slightly and try it again. 
If the patient complains of pain while the fluid is running, 
stop the flow for a few minutes to allow the gas (which is 
causing the pain) to disappear, so that the patient can 
retain the additional fluid more comfortably. When the 
required amount has been given, withdraw the tube slowly 
and press a towel against the anus, or opening of the 
rectum. This enema should, if possible, be retained ten 
minutes. 

If a bed pan is to be used, turn the patient on the back, 
bend the knees, raise the hips and place the pan in po- 
sition. Fold the end of the sheet (which is already under 
the patient) over the legs to protect the bedding. After 
removing the bed pan, turn the patient on her side, wash 
off the part carefully with soap and water and dry. Re- 
move the rubber and extra sheet and arrange the night- 
gown and bedding. 

If a commode is to be used, have it convenient to the 
bed. Put on patient's stockings, slippers and wrapper, 
and assist to the commode. Place a blanket over the legs, 
a hassock under the feet, and a low chair in front which 
can be used to lean on in case the patient feels faint or 
wants to relax the abdominal muscles. 

Funnel and rectal tube method. Another ap- 
paratus frequently used for a simple enema is a funnel 
with a rectal tube attached. In this case, the fluid is 
poured in the funnel from a pitcher. This method should 
always be used for an enema requiring only a small 



ENEMATA 



99 



amount. Have the fluid ready,— hold the funnel in the 
left hand and pinch the end of the tube between the thumb 
and the index linger. Fill the funnel, allowing the fluid 
to run to the end of the tube. Then pinch the tube at the 
funnel end while it is being inserted with the right hand 
and control the speed of the flow by pressing the tube with 
the finger. If necessary, refill the funnel, being careful to 
do so before it becomes entirely empty and pinch the tube 
before finally withdrawing it to prevent air being car- 
ried in. 

LAXATIVE OR OIL ENEMA 

This is frequently used when the patient is very con- 
stipated to soften the fecal matter and it consists of 6 to 8 
ounces of olive oil at a temperature of 105°. This should 
be given as a high enema, very slowly, by means of a rectal 
tube and funnel, and may be retained an hour. This is 
sometimes followed by a simple enema if not effectual. 

NUTRITIVE ENEMA 

This is prescribed when food cannot be taken in the 
usual way and, as the large intestine has not the power 
to digest but only to absorb it, the food for this purpose 
must be predigested. This may be peptonized milk or beef 
extracts combined with other ingredients as ordered. The 
usual amount is 4-6 ounces at intervals of 4-6 hours 
and at a temperature of 100°. 

This is given by means of a rectal tube and funnel as 
described, but very slowly, almost drop by drop, so that 
the intestines will tolerate and retain it. 

A simple enema is given once in 24 hours while a patient 
is being fed by rectum. 

STIMULATING ENEMA 

This can be used in emergencies. It is given at a 
temperature of 110°-112° and its ingredients are gen- 
erally saline solution or strong coffee in a quantity 8-12 



100 PRACTICAL HOME NURSING 



ounces, or if whiskey is used, from y<% to 1 ounce included 
in the total amount of fluid. 

RECTAL SALINE IRRIGATION 

Normal salt or saline solution is made by adding l 1 /^ 
teaspoonfuls of common salt to one quart of water and 
boiling it. In this proportion, the solution is not irritat- 
ing to the surface and is very generally used for all sorts 
of irrigations. 

Articles needed. Beside the usual articles necessary 
for giving an enema have ready 6-12 quarts of the above 
solution at a temperature of 100° ; also an irrigating bag 
with the usual tubing and clamp and, connected to this, 
a glass T tube. To one of the arms of this glass a rectal 
tube is connected and to the third opening a piece of 
tubing 3 feet in length, fitted with a clamp, is attached. 

Method of giving. Prepare the patient as for a sim- 
ple enema and place a foot tub on the floor beside the bed. 
Fill the bag with the solution and hang it two feet above 
the patient. Place the tubing to carry off the return flow 
in the foot tub, fasten the glass T tube to the sheet with 
a safety pin, then introduce the oiled rectal tube and allow 
a pint of the solution to pass in, clamp off that flow, and 
open the other clamp to let the outflow escape. This is 
kept up until the required amount has been given, opening 
and shutting the alternate clamps to allow the solution to 
run in and out. 

Another method of using tubes. Make the same 
preparations as above except that in this case two rectal 
tubes are used. Connect with the bag in the usual way 
and join the second to a piece of rubber tubing to make it 
long enough to reach the foot tub. Both tubes exactly the 
same length are oiled and inserted together 8 inches into 



ENEMATA 



101 



the rectum, then one is withdrawn 2 inches and kept in 
that position while the flow runs steadily in and out at 
the same time. 

In all cases of rectal irrigation, unless there has been a 
normal movement from the intestines, a simple enema is 
given before the irrigation, to clear away the fecal matter. 

VAGINAL DOUCHE 
A vaginal douche is given to wash off the surface of the 
vagina. 

For the purpose of cleanliness or as a treatment 
for continuous heat. 

For a simple douche a saline solution may be used or a 
boracic acid solution of 1 per cent. ; other kinds, including 
strong disinfectants, would be ordered by the physician. 

Four to eight quarts should be prepared at a tempera- 
ture of 108-112°. 

Articles needed. 

Douche pan Solution 

Rubber bag and tubing Sheet 

Sterile douche nozzle Towel 

Douche nozzles are made of hard rubber or glass with the 
holes in the side. 

Method of giving. Arrange the patient in position on 
the back with the knees flexed and head low ; raise the hips 
and draw the gown and place the douche pan beneath, put- 
ting a folded towel as a cushion on the seat part of the pan. 
Fold the bed clothes partly back over one leg and place a 
folded sheet around the other to prevent exposure; wash 
off any discharge from the vagina. Have the bag con- 
taining the solution arranged two feet above the patient; 
expel the air and introduce the nozzle downward and back- 
ward about 4 inches, allowing the solution to run in with 
a slow but steady flow. In removing the pan after the 



102 PRACTICAL HOME NURSING 



water is expelled be careful not to spill the contents. Dry 
off the part, pull down the gown and let the patient rest. 

EAR IRRIGATION 

This is given to wash out the canal of the ear, or for 
the application of heat to relieve pain. The solutions most 
commonly used are normal saline solution or boracic acid, 
2 per cent., at a temperature of 105° or hotter. 

Articles needed. 

Basin Bag and tubing Cotton 

Towel Sterile glass tip Solution 

Method of giving. Wash off any discharge on the 
ear. Have the patient sitting up or at least with the head 
raised, and place a basin under the ear. Hang the bag 
containing the solution a foot above the head. Hold the 
ear backward and upward to straighten the passage and, 
after expelling the air from the tube, direct the fluid into 
the ear but do not close the opening with the tip as there 
must be a space to allow for the return flow. When the 
required amount has been given, wipe out any remaining 
moisture with a piece of cotton, rolled firmly, and lay 
the patient on the affected side to drain out any fluid. 

Another method of irrigating the ear is to use a return 
flow nozzle which is attached to the bag in the usual way 
but with an additional piece of tubing attached to the other 
branch of the main tube. This allows for a continual flow 
in and out of the ear. The nozzle in this case is placed in 
the opening. 

Note. An ear should not be syringed without orders 
from a physician. 

NASAL IRRIGATION 

A nasal irrigation or douche is given to cleanse the nasal 
cavity and usually consists of normal saline solution or 
boracic solution, 2 per cent., at a temperature of 105°. 



ENEMATA 



103 



Articles Needed. 

1-2 quarts of solution Basin 
Irrigator bag and nasal Towel and handkerchief 
tip 

Method of giving. Arrange the patient sitting up, 
with the head bent down over the basin and the mouth 
open, as the breathing is to be through the mouth the 
entire time of the treatment. Warn the patient not to 
turn the head on the side. Hang the bag so that the lower 
part is on a level with the patient's head (to prevent too 
much force). Insert the nasal tip in both nostrils alter- 
nately and the fluid running through will wash the cavity. 

The position of the patient in this case is important in 
order to prevent discharge being carried into the Eusta- 
chian tubes which extend from the throat to the ear and 
through which infection is easily carried. 

THROAT IRRIGATIONS 

These are ordered for cleansing the throat or reducing 
inflammation by a continuous flow of hot salt solution. 
About 4 quarts can be used at a temperature of 108° or 
hotter if the patient can stand it. 

Articles needed. 

Solution to be used Basin 
Bag and tube Towel 

Any tube with an opening in the end can be used. The 
best is a glass tube 8 inches long with a curve of two inches 
more at one end. 

Method of giving. Have the patient sitting with 
head bent down over the basin and place a towel around 
the neck. Hang the bag 2 feet above the head, insert the 
tube well back on the top of the tongue and let the water 
flow in and out, keeping the mouth open and not breath- 
ing through the nose. 



104 PRACTICAL HOME NURSING 



EYE IRRIGATION 

This is given to allay inflammation or to cleanse the 
eye from discharges. Boracic solution, being non-irritat- 
ing, is generally the fluid used, 2-4 per cent, at tempera- 
ture of 100°. 



Articles needed. 

1-2 pints of solution 
Basin 

Sterile eye dropper 
Towel 



Cotton 

Small vessel (to catch dis- 
charge) 



Method of giving. Wipe off any discharge on the eye- 
lid first with a swab of cotton wet in the solution. Then 
open the lids with two fingers, taking care not to press on 
the eyeball but on the bone above the eye, and drop the 
fluid in with a dropper or a piece of cotton, washing from 
the inside out to prevent infection being carried to the 
other eye. If both eyes are affected, wash each one sep- 
arately, that is, with separate cloths. In fact, a fresh piece 
of cotton should be used for each application. 

If an eye cup is used, fill it half full with the solution, 
place firmly against the eye, throw the head back and 
have patient open and close the eye several times while 
the fluid is still against the eye. 



ENEMATA 



105 



QUESTIONS 

What is an enema? 

Name different kinds of enemata. 

In what position would patient be placed for this treat- 
ment ? 

Describe the process of giving a soap suds enema. 
What different purposes are saline irrigations of the in- 
testines used for ? 
Describe methods of giving same. 

Name important points in process of irrigating an ear. 
What position should patient be in for nasal irrigations ? 

— why ? 
How wash out an eye? 

Why is absolute cleanliness important in all these treat- 
ments ? 

What is a vaginal douche given for? 
State the amount — the solution used. 



CHAPTER XIII 



EXTERNAL APPLICATIONS 

External applications are used frequently in the care 
of the sick, in various forms and for different reasons, and 
must always be applied with the greatest care. They con- 
sist of dry heat, moist heat, poultices, counter-irritants, 
and cold applications — moist and dry. 

EXTERNAL HEAT 

This is used 

(1) to give warmth to the body and in that way 

stimulate it, 

(2) to promote free perspiration, 

(3) to relieve pain. 

Heat relieves pain by increasing the circulation of the 
affected part, thus removing the congestion which, by pres- 
sure on the nerves, causes pain in many cases. 

Dry heat. For this purpose may be used electric pads 
or hot water bags. With the former, while they are 
most convenient, there is some danger attached to their 
use and they must be constantly watched as the heat in- 
creases gradually and is liable to become too hot and burn 
the part. Also be sure that the pad is in a thoroughly 
good condition and that the insulating material is intact 
to prevent accidents by fire. 

Method of filling a hot water bag. A hot water 

bag is the most generally used method of applying dry 
heat. Have the water below boiling point — and not above 
180° — and half fill the bag with it. If the water is 

106 



EXTERNAL APPLICATIONS 



107 



poured in by means of a funnel it goes directly into the 
bag without injuring the rubber cenient at the neck of the 
bag ; it is also the most convenient way of filling it. Screw 
on the stopper securely and invert the bag to test for leak- 
age, then place it in a washable cover. 

The air in the bag can be left if it is used for such a 
purpose as against the feet, but in order to make it pliable 
and adjustable, the air should be expelled by pressing it 
out before the stopper is inserted. 

If this method of dry heat is to be used over a very 
sensitive part, lessen the weight by putting very little 
water in the bag. 

When not in use, a rubber bag should be filled with air 
which distends the sides and prevents them from sticking 
together. Have the rubber washer on the stopper replaced 
by a new one if worn thin. 

Metal or crockery bottles are durable but not as con- 
venient, and can be used only at the feet or to warm a cer- 
tain area. 

Dry heat can also be applied by means of hot salt bags, 
the salt being heated before placing it in the bag, or by 
hot blankets. 

Moist heat. Moist heat is more penetrating than 
dry heat and by relaxing the muscles and tissues, quickens 
the circulation and thus eases pain. For this purpose are 
used: (1) hot or warm baths, (2) fomentations, (3) poul- 
tices, or (4) hot compresses. 

HOT FOMENTATIONS OR STUPES 

By this means, moist heat is applied continuously for a 
certain period of time, to various parts of the body. They 
are most commonly used on the abdomen to relieve pain 
arising chiefly from an accumulation of gas which distends 
the abdomen and causes a great deal of distress. In such 



108 PRACTICAL HOME NURSING 



a case a rectal tube is sometimes inserted into the rectum 
and left there during the treatment to make a channel 
through which the gas passes off more readily. The free 
end of the tube should be in some receptacle to receive any 
fecal matter discharged with the gas. 

Articles needed. 

2 basins Lubricant 
A blanket Stupe cover 
Large towel Stupe wringer 

% yd. gauze Turpentine if required 

3 pieces flannel Boiling water 

Some apparatus for heating water near at hand 

For the cover, a layer of flannel and oil silk fastened 
together will be found most serviceable but flannel and 
brown paper used in the same way make an excellent sub- 
stitute. Such a cover should be light in weight and as 
air-tight as possible and much larger than the area to be 
covered. 

A stupe wringer is made with a piece of coarse toweling 
about V2 yard long with a two-inch hem turned in at 
either end. Two thin, round sticks longer than the width 
of the towel are run through the hems. The stupe can 
then be laid on the toweling and wrung nearly dry with 
the help of the sticks, turning them in opposite directions. 
In place of the wringer, a crash towel can be used in much 
the same way. 

Method of applying. Turn back the bedclothes to 
below the abdomen, replacing them with a blanket. Draw 
the gown up out of the way and arrange a tightly rolled 
large towel around the abdomen in a circle to prevent the 
bedding getting damp. Oil the surface of the abdomen 
and protect with a piece of gauze. On top of that place the 
stupe cover and fold the blanket back from that part. 



EXTERNAL APPLICATIONS 109 



Place the flannel inside the wringer or towel and dip this 
into a basin of boiling water (which should be at hand) 
leaving the ends of the wringer outside the basin where 
they can be handled. Wring the flannel very dry by 
twisting the two ends in opposite directions. Place the 
wringer in an empty basin, remove the flannel, shake 
slightly, draw the gauze protector away and apply the 
flannel stupe directly to the skin, passing it under the 
stupe cover. These flannels are changed every five min- 
utes and always under cover. This treatment is usually 
kept up from half an hour to an hour. After removing 
the heat, dry or oil the skin and cover with flannel or a 
warm protector. 

If turpentine is ordered, this can be put into the water 
in the basin — about 1 teaspoonful to a quart of water — 
or a safer way to prevent blistering of the skin is to mix 
one part of turpentine with three parts of oil and wipe this 
over the surface before applying the stupe. However, this 
should not be applied more than three times during the 
entire treatment. 

Fomentations are also applied over the chest, throat or 
other parts of the body by the same method. 

A hot compress. These can be made of gauze or thin 
flannel wrung out of hot water, the temperature of this 
varying from 116° to 120°, and applied to the part, and 
changed every two minutes. No cover will be needed. 
This treatment is kept up usually from half an hour to an 
hour. If there is any discharge from the part, such as 
from an eye, a fresh compress should be used each time. 

A convenient arrangement is to have a chafing dish near 
the bed and the compress kept in hot water there, ready 
for use. 

POULTICES 

Poultices can be made of any non-irritating substance 
that will retain heat, the size and shape depending upon 



110 



PRACTICAL HOME NURSING 



the surface to be covered. The poultice is put in gauze or 
thin muslin and will require a cover (as described in 
stupes) to retain the heat. 

Articles needed. 

Flaxseed Sauce pan Cover 
Water Gauze Lubricant 

Method of applying flaxseed poultice. Flaxseed or 
linseed meal is generally used for poultices as this contains 
oil which makes it penetrating and more effective. For 
a poultice about six inches square, allow 1 pint of water, 
% lb. of flaxseed and % yd. of gauze. When the water is 
boiling, add enough of the meal to make a paste which 
will drop semi-solid from the spoon. Then continue the 
boiling from 3 to 5 minutes, beating constantly. This in- 
corporates it with the air which makes it light in weight, 
while at the same time it thickens with boiling. A half 
teaspoonful of bicarbonate of soda added during the beat- 
ing will help to make it still lighter. 

Spread this poultice about an inch thick on the center of 
the gauze, folding the extra gauze over from side to side, 
then from the ends, placing one inside the other to make it 
secure. Carry this with its cover on a warm plate or 
tray, to the patient's side. 

Adjust a binder to hold it in place under the part to be 
poulticed, leaving the ends outspread. Oil the skin, test 
the poultice for heat with the back of the hand, and apply 
it directly to the part, slightly raising the corners of the 
poultice from the skin until the patient becomes accus- 
tomed to the heat. Place the cover over this and adjust 
the ends of the binder to hold it in place. This will 
usually keep warm about an hour, and if necessary to con- 
tinue the treatment, a fresh poultice must be ready before 
the other is removed. Afterwards dry and oil the skin 
and keep the part well covered with a warm protector. 



EXTERNAL APPLICATIONS 



111 



Mustard is sometimes added to such a poultice in the 
proportion of 1 part of mustard to 8 or 10 of flaxseed, 
it should be dissolved in a little cold water and added after 
the poultice is cooked, and well beaten into it. 

Starch poultice. This is made by dissolving laundry 
starch or corn starch in cold water and then adding it to 
boiling water which thickens it. It is spread on a muslin 
surface and when cool enough, applied directly to the part. 
This is often used for its soothing effect on an irritated 
surface. 

Bran poultice. Bran is placed inside a bag, dipped in 
boiling water, wrung out in a cloth and applied to the part, 
and kept covered. 

COUNTER-IRRITANTS 

These are agents which, by their irritant action, increase 
the flow of blood to one part thus attracting it from an- 
other, thereby relieving pain by reducing congestion in 
any one place. 

The simplest counter-irritants are hot water bag, mus- 
tard paste, tincture of iodine, turpentine and camphorated 
oil. 

Mustard plaster or paste. These are made with mus- 
tard, flour and water or, if the skin is very sensitive to 
blistering, the white of egg can be used instead of water. 
For a paste six inches square about 6 level tablespoonfuls 
of the material will be needed and a half a yard square of 
gauze. 

Table for mustard paste. 

Medium 1 part mustard to 5 parts flour 

Stronger 1 part mustard to 4 parts flour 

Weaker 1 part mustard to 8 or 10 parts 

(for children) flour 



112 PRACTICAL HOME NURSING 



Method. Mix mustard and flour together dry, add 
tepid water to make a paste ; spread this on the center of 
the gauze leaving a margin all around the paste. Then 
fold over the extra gauze from side to side, and from end 
to end, fastening one inside the other securely. Place 
this on a warm plate to remove the chill from the surface, 
before bringing it to the patient. 

Method of applying. Oil the surface of the skin and 
apply the paste, and hold in place with a light binder. 
This is usually left on from 10 to 20 minutes. Guard 
against burning by raising the edges of the plaster and 
looking at the skin which should be red, but not a dark 
red. After removing the paste, wipe the skin with a soft 
cloth or wash over the surface to prevent the mustard oil 
from further action on the skin. Then apply cold cream 
or vaseline, or simply powder, and place a smooth, soft 
cloth over the part. 

Mustard leaves. Mustard leaves can be obtained 
ready for use. They are made of mustard in combina- 
tion with a substance that adheres to a muslin foundation. 
To apply, dip the plaster in tepid water for a minute and 
after oiling the skin, place this on it, leaving it there for 
about 10 or 20 minutes or until sufficiently red. After 
removing, wipe off the skin and oil the surface as de- 
scribed above. 

Tincture of iodine. This is applied to the skin by 
brushing it over the surface with a camel's hair brush, or 
a piece of cotton attached to a small stick. If too much 
or too strong iodine is put on the surface and burns se- 
verely, wash it off with alcohol. 

Note : Tincture of iodine must always be fresh or the 
alcohol in which it is dissolved may have evaporated and 
left too large a proportion of iodine. 

Liniments. Liniments and various oils are applied 



EXTERNAL APPLICATIONS 113 



to the skin with a piece of cotton, and then rubbed in by 
friction with the hands. 

Ointments can be applied in the same way or they may 
be spread on muslin and placed on the skin, and kept there 
by a bandage or strips of adhesive plaster. 

COLD APPLICATIONS 

Cold is employed to allay inflammation, to relieve pain, 
to keep the blood from congesting in any one part, and is 
used in the form of ice bags or cold compresses, and these 
kept continually cold. 

Ice bag. Ice bags are usually made of rubber, fitted 
with a metal screw top. They should be about half filled 
with chopped ice and the air pressed out, then wrapped in 
a musliu or gauze cover to prevent over-chilling or freezing 
the part to which applied. The ice should be constantly 
replenished to prevent their getting warm. 

To relieve the weight of the ice bag. If the weight 
of the bag is uncomfortable, it can be arranged so that 
the cold surface rests on the part without the pressure. 
If to be placed on the head, a piece of tape can be tied 
around the metal top and adjusted to allow the bag to 
hang from the top of the bedstead and just touch the 
head ; or if applied on the knee, for instance, a support of 
some firm kind can be placed on either side to support 
the sides of the bag, letting it barely come in contact with 
the skin. 

Care of bag. After using, dry the inside of the bag 
thoroughly and screw on the metal top with its rubber 
washer, leaving sufficient air to keep the sides from stick- 
ing together. 



114 PRACTICAL HOME NURSING 



Cold compress. Fold two pieces of gauze or thin, 
soft muslin in the required size, with the edges folded in- 
side. Have a basin nearby in which there is a large piece 
of ice and some water. Soak the compresses in the water 
and cool them on the ice, applying them alternately to the 
part — one being constantly on the ice. 

Compresses for the eyes. In this case, if there is 
any discharge from the eyes, use a fresh compress each 
time. For this purpose the gauze is usually cut in oval 
shape, larger than the eyes and % inch thick, and can be 
chilled and changed as described above. Sometimes the 
treatment calls for cold and hot compresses to be applied 
alternately. 

QUESTIONS 

For what reason is heat applied ? 

How does it relieve pain ? 

How does cold relieve pain ? 

Describe common methods of applying heat. 

How may cold be applied to a part ? 

How apply hot fomentations to abdomen ? 

What danger to patient from hot applications ? 

How avoid this danger ? 



i 



EXTERNAL APPLICATIONS 



115 



FOR THE COMFORT OF THE PATIENT 

Amongst the little details that go to make up the sum 
comfort of the patient a few of the most essential may be 
considered in the following suggestions : 

Change the patient's position frequently and use a foot 
rest to prevent strain on the muscles. 

Have the patient's person and surroundings clean. Give 
an extra alcohol rub in hot weather. 

Keep the room quiet and cool and have the bed comfortably 
made and bed clothes loose enough over the feet. 

Give treatments with quiet confidence. Do it quickly and 
quietly and concentrate your mind on doing it. 

Serve food and drink attractively, prepare and season it 
in as many different ways as possible. 

Be cheerful and resourceful yourself and keep the sea 
smooth. Answer the patient's questions in a satisfac- 
tory way and not evasively. Anticipate harmless de- 
sires of the patient and study her or his likes or dis- 
likes. Know when you have done enough and don't 
fuss over it and never try to entertain too much. 

Leave the patient sometimes alone. 

Be interested in the patient's personal responsibilities. 

Try to prevent small household worries from reaching the 
patient. 

Do not become careless in detail during convalescence. 

Have the room darkened for the patient to rest for an 
hour a day. 



CHAPTER XIV 



MEDICINES 

Medicine may be given by mouth, through the skin or 
by rectum. It is usually in the form of fluids, pills, pow- 
ders, tablets, or capsules; also medicated ointments are 
applied externally or suppositories are inserted in the 
rectum. 

MEASURES 

Dry Measure Fluid Measure 

60 grains .... 1 dram 60 minims 1 dram 

8 drams .... 1 ounce 8 drams 1 ounce 

(480 grains ....1 ounce) 16 ounces 1 pint 

2 pints . . 1 quart 

4 quarts 1 gallon 

Approximate equivalent 

1 teaspoonful . ., 1 dram 

1 tablespoonful % ounce 

1 glass (if full) 8 oz. 

2 glassfuls 1 pint 

General rules for giving medicine. 

1. Always read the label twice, once before preparing 
the dose and again before giving it to the patient. 

2. Have the medicines fresh and clearly labeled, and 
keep them in a safe place. 

3. Medicines should be given in the exact quantity and 
at the intervals ordered, but if for any reason (such as a 
patient's being asleep) the dose is delayed, allow the 
usual interval between that and the next dose. For ex- 
ample, medicine due at 12 o'clock, 3, 6, etc. may be given 
at 1 o'clock if the patient awakes then, and after that at 4, 

116 



MEDICINES 



117 



7, 11, etc. Those ordered before meals are usually given 
15 minutes beforehand and those ordered after meals about 
15 minutes afterwards. 

In giving fluid medicine, shake the bottle thoroughly, 
wipe off the mouth of the bottle and pour the liquid from 
the side opposite the label so that it is kept clean and 
there is no danger of obliterating the directions. Measure 
fluids accurately by a minim dropper or a graduated glass, 
and dilute 2 to 3 times unless otherwise directed. 

Ice held in the mouth before giving oil or any dis- 
agreeable medicine dulls the sense of taste. 

Tablets, powders and capsules should be placed on the 

center of the tongue and followed at once by a drink of 
water to wash them down. In some cases, tablets are 
dissolved in water, or before being given are placed in a 
piece of bread or in a spoonful of jelly in order that they 
may be swallowed more easily. 

Among the most used common classes of medicines are : 
tonics (to tone up the parts, such as blood, nerves, stomach, 
etc.) ; stimulants (to improve heart action) ; sedatives 
(to quiet the nerves or ease pain) ; emetics (to cause vom- 
iting) ; and cathartics (to stimulate the muscular action 
of the bowels and produce a movement). 

COMMON HOUSEHOLD STIMULANTS 

(To be used in emergencies) 
Stimulants may be given internally by mouth or rectum 
or by inhalation. For inhaling, ammonia salts may be 
held to the nose, taking care not to spill any of its fluid 
which would burn the patient, nor to hold the bottle too 
near the face. A handkerchief saturated with aromatic 
spirits of ammonia may also be held to the nose with good 
effect, or plain ammonia used in the same way. 

Stimulants which can be given internally are : 



118 PRACTICAL HOME NURSING 



Whiskey or brandy — 1 tablespoonful diluted in at 
least % as much hot water. 

Aromatic spirits of ammonia — Y2 to 1 teaspoonful in 
2 tablespoonfuls of cold water. 

Coffee, strong and clear, from % to 1 cupful (the stimu- 
lant is caffeine). 

Extract of coffee, 1 tablespoonful to a cup of boiling 
water. 

Tea, strong and clear (the stimulant is theine). 

Ginger tea, made with 2 tablespoonfuls of powdered 
ginger to 1 cup of boiling water, steeped and strained ; or 
syrup of ginger, 2 drams in % cup of water. 

No attempt should be made to administer stimulants or 
other medicines by mouth unless a patient is fully con- 
scious, except aromatic spirits of ammonia in very small 
doses, which can be absorbed by tongue. 

Coffee and alcoholic stimulants may be administered by 
rectum. 

(See Enemata, page 99.) 

EMETICS 

These are given to cause vomiting. The common 
emetics are : 

Strong salt and water (3 teaspoonfuls of salt to 1 glass 
of water which makes it sufficiently irritating to 
produce the desired effect). 

Mustard and water (1-2 teaspoonfuls of powdered mus- 
tard to a glass of water). 

Syrup of ipecac ( Vi to 1 teaspoonful, taken undiluted). 



MEDICINES 



119 



Running the finger down the throat will frequently pro- 
duce vomiting without emetics, or warm water given con- 
tinually until vomiting is produced. 

CATHARTICS 

This class of medicines is given to stimulate the 
muscles of the intestines and cause a free action from 
them. Some cathartics produce the effect slowly and 
these should be given at night. Others, producing a quick 
effect, are given in the morning. Of this latter class, 
castor oil is most frequently ordered in doses of from 1 
teaspoonful for an infant to 3 tablespoonfuls for an adult. 
As this has a very nauseating taste, it must be carefully 
prepared to enable a patient to take and retain it. It can 
be more easily taken in any ice-cold fluid, even ice water, 
or ice water and lemon juice, or whiskey. Pour this in a 
small glass, rinsing it around the edge first ; then pour the 
oil, also cold, in the center and the oil will thus be kept 
intact. Swallow quickly and the oil goes down on the 
water easily; then take some strong flavor in the mouth, 
such as peppermint and lie down to prevent nausea. For 
a child, the oil can be placed in the same way on top of a 
little cold fluid in a spoon ; then place the spoon well back 
on the tongue and hold it there until its contents are 
swallowed. This prevents closing the teeth and giving an 
opportunity of spitting the oil out. Olive oil in the same 
quantity may be substituted for castor oil. 

Calomel is another cathartic frequently prescribed, and 
usually in doses of from 1 to 2 grains. This may be 
given in one dose or in /i grain doses every 20 minutes 
with water each time until the required amount has been 
taken. Five grains of bicarbonate of soda with each dose 
helps prevent irritation in the stomach and consequent 
nausea. Calomel is given at night and is invariably fol- 
lowed the next morning by a cathartic such as magnesia, 
or any of the laxative mineral waters. Food should not 



120 PRACTICAL HOME NURSING 



be taken for 1 to 2 hours after this second laxative and 
then only a hot drink, as otherwise the patient will become 
nauseated. 

Other kinds of cathartics are in the form of pills, cap- 
sules, tablets or fluids and these would be given at night 
as their action is slow. 

Suppositories are also used to cause a movement from 
the intestines ; they are cone shaped substances made of 
cocoa butter, gluten or glycerine and are placed in the 
rectum. 

To insert a suppository, oil both it and the little finger 
and push it far into the rectum. 

Medicated suppositories are used as a medium for in- 
troducing drugs into the system. 

ACIDS AND ALKALIES 

These are substances that counteract the effect of each 
other and neutralize. 



Mouth washes. 

Soda and water (1 teaspoonful to 1 glass). 
Listerine or borine diluted % with water. 
Water with 10 drops of alcohol to a glass. 
Saline solution. 

Boracic acid, saturated solution or diluted, as desired. 



Acids 

Lemon juice 
Vinegar 



Bicarbonate of Soda 
Lime water 
Magnesia 



Alkalies 



f Lemon juice 2 tbsps. 
-< Glycerine 2 tsps. 
[ Water % glass. 



MEDICINES 



121 



Gargles. 

'Lemon 4 tbsps. 

Glycerine 1 tbsp. 

Water % glass. 
„Soda % tsp. 

Very hot saline solution. 

f Vinegar 1 part. 
I Water 4 parts. 

QUESTIONS 

Mention important points in the giving of any medicine. 
How guard against making a mistake in giving a medi- 
cine ? 

Name stimulants that could be used for inhaling. 
Mention common emetics. 
Mention common stimulants. 

How prepare a dose of castor oil for adult — child ? 
What could be used for a mouth wash ? 
What could be used for a gargle \ 



122 PRACTICAL HOME NURSING 



SUGGESTIONS FOR CONTENTS OF A CONVEN- 
IENT HOUSEHOLD MEDICINE CLOSET 



Alcohol 

Whiskey or brandy 
Aromatic spirits of ammo- 
nia 

Smelling salts 

Headache cologne 

Baume Analgesique (to rub 

on for pain) 
Olive oil 
Castor oil 

Magnesia granules (effer- 
vescing) 
Seidlitz powders 
Syrup of ginger 
Syrup of ipecac 
Essence of peppermint 
Soda mints 
Mustard 

Bicarbonate of soda (bak- 
ing soda) 
Lime water 
Boracic powder 
Solution of boracic acid 
Glass jar of sterile water 
Small basins 



Pond's extract 

Vaseline 

Albolin 

Cold cream and Pond's ex- 
tract (equal parts) 

Oxide of zinc ointment 

Small package of sterile cot- 
ton and gauze 

Sterile gauze bandages, 1 
and 2 inch widths 

Roll of adhesive plaster 

Hot water bag 

Ice bag 

Fountain syringe bag or an 
enamel irrigating can 

Tubing and tips for syring- 
ing 

A measuring glass 

A dropper and eye cup 

Glass drinking tube 

Small glass 

Measure spoon 

Rubber tissue 

Assorted bandages 

Roll of old flannel and linen 



CHAPTER XV 



SYMPTOMS 

Observation of symptoms. One of the chief respon- 
sibilities in connection with nursing the sick is that of 
training the mind to acquire the habit of observing 
changes that occur in the patient's condition. Nothing is 
too trivial to notice. Slight changes may give warning of 
a serious condition approaching which if discovered early, 
might prevent acute developments later. State the facts 
in regard to observations as clearly and accurately as 
possible to the physician. 

The mind must be alert and keen to do this well and to 
have an understanding of the patient, and the conditions 
that normally surround her. These changes are usually 
spoken of as symptoms which are classified as follows : 

Subjective are those realized b} r the patient alone, such 
as pain, headache, nausea, chilliness, defects in hearing or 
seeing. 

Objective are those visible to the onlooker, such as the 
position taken, the color and general appearance. 

Constitutional are those which affect the whole body, 
for example, fever. 

Local are those restricted to any special part, as a 
swollen knee, a sore throat, etc. 

Symptoms may indicate either a state of the body, 
mind or nerves and their severity usually increases to- 
wards night. The increase or decrease of strength from 
day to day is indicated by small things that need close ob- 
servation: was the patient less tired after sitting up to-day 
than yesterday? Could she walk a longer distance to- 



124 PRACTICAL HOME NURSING 



day ? Did she seem less nervously tired ? Was the voice 
stronger or weaker \ Was the attitude of mind more de- 
pressed or cheerful ? Her nervousness less apparent ? 
Was the attitude of the body alert, tense or relaxed '( Had 
the appetite improved and was there loss or increase of 
weight ? 

Pain. It is difficult to define suffering or pain, or to 
report on it, because the patient only can tell the severity 
or character of it. Some bear pain almost stoically, while 
others, having less power of endurance, grow restless and 
nervous and sometimes magnify to themselves the degree 
of their suffering. 

Notice the expression of the face, also the position 
taken, for a patient almost instinctively takes that which 
gives the most comfort : — when the pain is in the abdo- 
men, the patient will draw up the legs toward the body to 
relax the muscles and relieve tension ; if the pain is in the 
head, this is instinctively raised up to prevent too much 
blood going there and causing pressure. Notice if sup- 
porting an injured or aching part or elevating it, give 
relief and if the pain is darting or piercing, if there are 
intervals of relief, or if it is a steady ache. A pain the 
patients complain of as " boring " is usually the result of 
pressure and needs the removal of that pressure to ease it. 
It is important to observe how pain is affected by heat or 
cold, rest or motion, such as rubbing, or by the lessening 
of light and sound. Surface pain is increased by light 
pressure; deep-seated pain by deep pressure. 

Sleep. During illness, sleep is more or less unnatural, 
and the result of loss of sleep is felt on the heart action as 
normally it beats slower during sleep, and this reacts on 
the system generally. Some of the particular points to 
notice about a patient's sleep are: the actual time if pos- 
sible — as a patient is not a good judge of this ; also if it 
is sound, continuous and quiet or if the patient is restless, 



SYMPTOMS 



125 



waking up often, and talking or muttering. Another 
point to be noticed is whether the breathing is through the 
nose or mouth, and if the latter, it should be reported ; 
also if the eyes are closed or partially opened. Patients 
are usually not waked for food or medicine, but this de- 
pends upon the physician's orders. The return to natural 
sleep is often a turning point in an illness, and is always 
a favorable symptom, and everything should be done to 
induce sleep. Quietness and darkness generally encourage 
it and for further suggestions, refer to treatment on in- 
somnia (page 137). 

Position. Even when not considered in connection 
with pain, the position taken by a patient is important to 
notice. When there is distress from various causes in the 
abdomen, patients will draw up the knee and lie either on 
the back or on the side as this relaxes the muscles and re- 
lieves the tension. When pressures give relief, as in colic, 
they will lie over on the abdomen. If a patient lies on 
the back with no desire to change the position, it is often 
a sign of extreme weakness and in that case, the patient 
must be moved on the side at intervals to keep the circula- 
tion active in all parts. Lying continuously on one side 
may indicate local disease. Frequently in disease of the 
lungs the patient lies on the affected side to leave the other 
free and it is a sign of improvement when a turn can be 
made over to the other side. The position on the right 
side is often taken in order to leave the action of the heart 
free. When there is difficulty in breathing a patient is 
not always able to lie down and should be supported com- 
fortably. Notice the position that eases and in which the 
patient can sleep best. For methods of supporting with 
rests and pillows see page 71. 

Appetite. The appetite can only be considered in con- 
nection with other symptoms and is more or less allied 
with the condition of digestion or indigestion. Sometimes 



126 PRACTICAL HOME NURSING 



patients are considered to have no appetite when all that 
they need is food that they like. Observe closely what 
leads to loss of appetite, it may be only over fatigue, 
either physical or nervous or, as the result of depression, 
and the patient doesn't want food, or only picks at it. In 
acute illness from fever and various causes, the appetite 
fails just as other parts of the body are affected. This is 
often from the exhaustion of illness and the effort required 
to take food. Notice if the appetite improves as the 
strength does, and whether the desire for all food is lost or 
if certain kinds appeal to them. 

The secretion of digestive juices is stimulated through 
the nerves by taste, smell, sight ; and the manner in which 
food is offered to a patient has a great deal to do with the 
appetite. A loss of appetite is also due to lack of digestive 
juices, or to the lack of certain constituents in them. In 
this case, tonics are given to overcome this condition and 
to restore the appetite. 

Thirst should be noted as it defines a lack of fluid in 
the blood or tissues. 

Skin. The color of the skin varies in disease : pale as 
in fainting; red or flushed with fever; yellow as in jaun- 
dice; or bluish when the blood is very much congested. 
Notice any rash or eruption and how it spreads and if 
the skin is dry or moist and if the nails are soft or hard ; 
whether there is any sign of puffiness of the skin (this 
often shows under the eyes or in the feet and legs and 
comes from an excess of fluid in the tissues). Also no- 
tice any swelling of the abdomen or any other parts such as 
the glands, and any indication of redness, chafing or ten- 
derness. A patient may complain of an itchiness on the 
surface of the skin when there is no rash to be seen. Any 
of these conditions should be reported carefully to the 
physician. 



SYMPTOMS 



127 



Tongue, mouth and breath. The condition of the 
tongue gives information as to the state of the digestive 
organs particularly. It is important to notice if it is dry 
or moist, furred and coated, if the edges and tip are red 
or sore (making it painful), and if swollen. If it is be- 
coming better or worse and if there are any signs of irri- 
tation on the surface of the mouth, or in the throat, and 
if there is an unpleasant odor from the breath. This 
usually arises from the condition of the stomach, unhealthy 
teeth, or from a catarrhal condition of the nose or throat. 

Feces. It is important to observe in regard to the feces, 
whether they are dry, hard, constipated, or if they show 
a tendency to soft, watery stools ; and if there is any evi- 
dence of undigested food or unnatural color. Also note 
the frequency of movement and if accompanied by pain or 
gas. 

Urine. Notice the frequency of passing urine and if 
there is any distress in connection with this, the color, the 
amount in twenty-four hours, and if it is clear or shows 
evidence of any sediment. 

Circulation. Observe if there is a tendency toward 
chilliness or if the hands and feet are apt to be cold. 

Temperature, respiration and pulse. Notice if the 
temperature varies from normal, either above or below and 
if the variation is continuous; the rate of the pulse and 
its character — whether strong and regular, or weak, also 
if the breathing is difficult or noisy and if it is eased by 
the head being raised ; if there is any cough, and whether 
this increases at night and is attended with expectoration 
(and the character of the sputum) ; if the cough is loose, 
dry, hacking, hoarse or comes in paroxysms, and if it 
causes any pain. 



128 PRACTICAL HOME NURSING 



Muscular weakness. Sometimes after an illness there 

is more or less weakness and in some eases paralysis of 
the muscles. Watch carefully for any sign of lameness 
or dragging of the feet, or lack of strength in the muscles 
of the arms; also any signs of twitching or unnatural 
movements of the muscles 4 

Bedside notes. It is much safer to record in writing 
the necessary points in regard to a patient's condition. It 
is an easier method, more reliable, more accurate, than try- 
ing to remember them, and the physician needs the neces- 
sary facts about the condition in a condensed way. In 
keeping bedside notes, state the facts clearly, give definite 
amounts as far as you can. Among the usual points are 
temperature, pulse, respiration, diet, sleep, medicine given, 
number of stools and amount of urine. Forms for bedside 
notes can be easily obtained at any drugstore and charts 
can also be obtained for recording the temperature in case 
of a persistent fever. 



Patient's Record 
Name Date 



Date 


Time 


Temp. 


Pulse 


Resp. 


Medicine 


Diet 


Fluids 


Stools 


Unne 


Remarks 

























CHAPTER XVI 



SPECIAL CAKE IN CONDITIONS RELATING TO THE FEMALE 
GENERATIVE ORGANS 

The female generative organs lying in the pelvic 
cavity consist of two ovaries each about an inch and a 
half in diameter in which the ovum or germ of life is 
secreted, and from these extend two Fallopian tubes 
about four or live inches long to the uterus which lies in 
the center of the cavity. This is also a small organ, 3-4 
inches long, 2 inches wide and 1 inch thick, composed of 
strong muscular tissue which enables it to expand during 
pregnancy and contract again afterward. Its function is 
to receive the ovum and, if the ovum becomes fecundated, 
to retain it during its development. The uterus is sus- 
pended by ligaments, is not attached to any bone and lies 
between the bladder and rectum. The vagina is the pass- 
age leading from the outside to the uterus. This is lined 
with mucous membrane and like all such membranes is 
susceptible to infection and to irritation from uncleanli- 
ness. 

The general health of a woman depends largely on the 
healthy condition of these organs as they are so closely 
allied to her nervous system. Constipation is apt to cause 
pressure on the uterus owing to its position which is di- 
rectly over the rectum, and is particularly harmful to a 
woman. 

Development of the generative organs. The devel- 
opment of these organs, spoken of as the time of puberty, 
commences at about fourteen years of age and they function 
until about fifty years of age. During that period at in- 
tervals of about one month, the ovaries develop and dis- 
charge an ovum which is passed by the tubes to the uterus 



130 PRACTICAL HOME NURSING 



and simultaneously a temporary congestion of the uterus 
occurs, the result of which is known as menstrual discharge, 
lasting for a few days. For the first day during that 
period there is consciousness of additional weight for which 
reason no very active exercise should be taken nor should 
too much physical or nervous strain be borne by a woman 
at such times. 

SPECIAL CARE OF THE SICK DURING 
NORMAL MENSTRUATION 

This care is largely precautionary. Any symptoms 
of disease are likely to be aggravated and the patient may 
feel a little depressed. There is also sometimes loss of 
appetite. Omit general baths for a couple of days so as 
pot to draw too much blood to the surface when it is needed 
for active circulation internally. Keep the patient quiet 
and free from worry. Restrict the diet somewhat and 
unless there is a free action of the bowels give an enema. 
As headache is a frequent complication, prevent glare or 
direct light or too much strain on the eyes from reading. 

PAINFUL MENSTRUATION 

There may be various indirect reasons for this pain rela- 
tive to unnatural uterine conditions, also nervousness, etc., 
but actual pain is usually due to congestion inside of the 
uterus which prevents free circulation, thus causing pres- 
sure on the nerves with consequent pain. Constipation is 
a common cause for such congestion on account of the posi- 
tion of the rectum under the uterus which brings pressure 
on that part. Another reason lies in the chilled blood re- 
turning to the body when the feet have been cold or wet 
for any length of time. 

Treatment. Heat applied is the chief treatment. 
This may be applied most directly to the uterus by giving 
a simple hot enema and after a movement has been induced, 
continue with a very hot low irrigation to increase the 



FEMALE GENERATIVE ORGANS 131 



circulation in the rectum which will affect that of the 
uterus. Keep the patient in bed if possible with knees 
flexed to relax the muscles and place a hot bag at her back 
and feet and another over the abdomen, or hot fomenta- 
tions may be applied. (See page 107.) A mustard foot 
bath is an effective means to increase general circulation. 
Give hot drinks ; ginger tea is excellent in this case as is 
also hot tea or coffee. If the patient is nauseated apply a 
mustard paste to the pit of the stomach. 

Suggestions for preventing pain. If there is a ten- 
dency to having pain at this time, try and prevent consti- 
pation (see page 133) before the period is due and relax 
the muscles by a warm bath. Keep the feet warm and 
restrict the usual diet a little. 

CESSATION OF MENSTRUATION 

Menstruation ceases when the ovaries become inactive 
and the extra amount of blood which had been sent to and 
utilized by the generative organs during the period of 
active function is then distributed to the general circula- 
tion and during the period (for some years) of this read- 
justment, many uncomfortable sensations are experienced 
such as sudden flushes, etc. Also the effect on the nerves 
is very noticeable and care should be taken to avoid physi- 
cal or nervous strain, or to become even overtired, to keep 
in the fresh air a good deal and occupy the mind with 
some new interest. 

VAGINA 

Any unusual discharge from the vagina should be re- 
ported and the usual treatment for such a condition would 
include a vaginal douche, directions for which are given 
on page 101. For treatment of hemorrhage from the 
Uterus (See "Emergencies," page 148). 



132 PRACTICAL HOME NURSING 



Positions for examination or treatment. For exam- 
inations or treatments of various kinds patients are placed 
in definite positions, and among the most commonly used 
are: — 

Dorsal position. Patient is placed on the back, head 
low, and knees flexed, and the legs are draped with a sheet. 

Sims position. Patient lies on the left side, with the 
left arm extended out at the back, head low. The left leg 
flexed, the right leg flexed with the heel almost touching 
the knee of the left leg, and legs are draped with a sheet. 

Knee and chest position. The patient kneels with the 
chest resting on the bed and the knees flexed at right angles 
to the body. 

QUESTIONS 

2STame the female generative organs. 
What is the function of the ovaries ? 

What care would a patient require during menstruation? 

Mention causes for painful menstruation. 

How relieve this condition ? 

How arrange a patient in the Sims position ? 

How arrange a patient in the Dorsal position ? 



CHAPTER XVII 



MINOR ILLNESSES AND DISORDERS 

HEADACHE 

Headache is a symptom of importance in disease and 
it may also be caused by slight digestive disorders, consti- 
pation, over fatigue, nerve strain (particularly of the 
eyes). The tendency to headache may, in many cases, be 
overcome by correcting these irregularities. 

The direct effect of headache pain is usually from con- 
gestion of blood in the head, which causes pressure on the 
nerves. Or it may be that tension, over-fatigue, etc., af- 
fects the nerves directly. 

Treatment. Try to remove the congestion by drawing 
the blood away from the head by such effective methods 
as : hot mustard foot bath, mustard paste between the shoul- 
ders just below the neck, heat or cold over the seat of the 
trouble, hot water bottle to the feet or to the back of the 
neck. Have patient lying down to rest the nerves, with 
the head high and the eyes protected from the light. 

CONSTIPATION 
Constipation is at all times a serious menace to a 
healthy condition of the body. When this exists the 
residue or waste of one part of the body is not expelled in 
the normal way by the muscular action of the colon but 
is retained in the system longer than usual and from this 
there is an absorption back into the tissues with the result 
that the patient has the symptoms resembling those of an 
enervating, slow poison, with consequent lack of energy, 
heaviness and irritability, besides the distress of an accu- 
mulation of gas in the abdomen. 



134 PRACTICAL HOME NURSING 



In time of illness there is a natural tendency to consti- 
pation due to the lack of general exercise and the conse- 
quent inactivity of the muscles of the intestines ; and also 
because the diet at such times consists of more condensed 
food, most of which is absorbed without leaving sufficient 
waste to stimulate the muscles of the colon and keep them 
active. 

Treatment. The influence of the habit of evacuating 
the bowels at a regular hour each day has the most per- 
manent effect in overcoming constipation, and even in time 
of illness this has proved an efficient help towards coun- 
teracting this tendency. 

Exercise the muscles of the legs which directly affect 
the intestinal muscles. The simplest way of doing this is 
to walk (even walking up and down stairs). If exercise 
can be combined with pleasure, so much the better. 

Rub the muscles of the colon in the natural direction up 
the right side, across the top and down the left side. 

Allow the patient to drink freely of water because 
fluids, being absorbed in the large intestines, stimulate the 
muscles there. Also give fruit and green vegetables for 
the sake of the mineral salts contained in them, which 
have the same effect. The fiber of the vegetables, well 
cooked and unstrained, as well as coarse grained cereals 
and breads are valuable in the diet as all of these leave 
more bulk or waste which is not absorbed, and their pres- 
ence in the colon stimulates the muscles to act and expel 
the feces from the rectum. 

An enema or laxative is frequently given to overcome 
this condition when other efforts fail. 

DIARRHCEA 
Diarrhoea is caused by increased intestinal peristalsis or 
increased intestinal secretion. The muscles of the intes- 
tines are over-stimulated, irritated or too much relaxed. 
This may be caused by undigested food, any irritating 
substance or from nervous conditions. 



MINOR ILLNESSES AND DISORDERS 135 



Treatment. Observe the movements: whether they 
contain undigested food, mucus, etc., also whether there 
are any traces of blood. The safest and quickest treat- 
ment is to give a large dose of castor oil to clear away the 
irritating cause. Keep the patient quiet, warm, if possible 
in bed, with hot water bottles at the abdomen and at the 
feet. For diet, give food that will be more easily di- 
gested in the stomach such as white of egg, scraped beef, 
Hour gruels, barley or rice water, toast. This diet gives 
very little effort to the intestines and enables them to rest. 
Give no fats and restrict fluids and provide a very simple 
diet afterwards. When there is a tendency to this condi- 
tion, special care should be taken in regard to the regular 
diet in order not to overstimulate or exercise the muscles 
of the intestines. A change of air and building up of the 
general system is usually advised to help overcome this 
tendency. 

FEVER 

Fever may be caused by a variety of conditions or may 
be the first symptom of a serious disorder. 

Treatment. In any case of fever, it is perfectly safe 
to bathe the patient with water, tepid or cold, using a 
great deal of water and allowing it to evaporate. Rub the 
body at the same time in order to bring the blood from 
the heated parts to the surface to cool it in turn. Keep a 
cold cloth or an ice bag on the head; have light covering 
over the patient and see that the room is cool. Give either 
an enema or a laxative to produce an effective action of the 
bowels, plenty of fluid to drink is required and a very light 
diet, usually fluid or semi-solid. Watch the temperature 
closely and when it falls remove cold from the head. 

CRAMPS OR COLIC 
Cramps or colic from gas in the abdomen are usually 
relieved by heat applied to the abdomen — either by hot 
water bags or by hot fomentations (page 107) or by im- 



136 PRACTICAL HOME NURSING 



mersing the body in hot water up to the waist line. Give 
an enema which, in this case could be made effective by a 
combination of 1 part of turpentine and 2 parts of sweet 
oil. A rectal tube inserted in the rectum and left there 
makes a passage through which gas may escape more easily. 
Ginger tea, essence of peppermint in hot water, or soda and 
hot water taken by mouth, sometimes give relief. 

EARACHE 

Earache may be caused by some indirect trouble with 
the teeth, or from cold, or by a purely local disease of the 
ear. 

Treatment. Have the patient keep the head raised on 
a pillow and lay the affected ear on a hot water bag (not 
too full). Lacking that, apply hot cloths or even a poul- 
tice over the outside ear. If persistent an earache may be 
relieved by careful syringing with hot water (108°), for 
method see page 102. An earache should always be re- 
ported to a physician even if it has been relieved. Care- 
fully note any sign of discharge. 

TOOTHACHE 

Treatment. Keep the head high on a pillow, and some 
temporary relief may be obtained by applying a swab of 
cotton, soaked in spirits of camphor or some form of alco- 
hol, directly on the gum around the tooth. This will prob- 
ably relieve the pain. A dental poultice can be used in 
the same way after soaking it a minute in warm water. 
Another remedy is to paint the gum with iodine. Oil of 
cloves may be dropped in the cavity of the tooth, or a small 
piece of cotton soaked in it inserted in the cavity. This 
at best can only afford temporary relief and as soon as 
possible the affected tooth should be examined by a dentist. 



MINOR ILLNESSES AND DISORDERS 137 



NEURALGIA 
Neuralgia. (Nerve pain) usually indicates a rather 
lowered general vitality of the patient and is best over- 
come permanently by improving the general conditions, 
securing good nourishing food, plenty of fresh air and 
sleep, and if possible a change of air. Look also for any 
local cause of the trouble, such as toothache or pressure on 
a nerve. 

Treatment. For immediate relief, heat should be ap- 
plied to the part where the pain is felt, also keep it as 
quiet as possible. Menthol pencils or menthol fluids ap- 
plied directly over the affected parts usually give relief. 

VOMITING — NAUSEA 

Vomiting may be caused by irritated nerves of the 
stomach, too great acidity or by bile or unsuitable food. 

Observe the vomited substance and if necessary pre- 
serve for the examination of the physician. 

Treatment. Lay patient down to relieve pressure on 
the nerves that lie back of the stomach, provide fresh air, 
apply a mustard paste over the pit of the stomach and give 
hot water in sips with a little soda in it (1 teaspoonful to 
a half glass) or pieces of ice to be swallowed whole, darken 
the room and try to induce sleep. If persistent give a 
glass full of water as hot as can be swallowed. 

INSOMNIA OR SLEEPLESSNESS 
Insomnia has many causes — too great activity of the 
brain, reflex action from over fatigue, nervousness, worry 
or from habit. 

Treatment. It is important to draw the blood away 
from the head by means of a warm bath, heat applied to 
the extremities either by mustard foot bath or a hot water 
bottle ; for the same reason some easily digested food, or a 
hot drink may be taken before going to bed ; this tends to 
draw the blood to the stomach during its digestion and 
thus relieves the amount in the head ; mustard plaster at 



138 



PRACTICAL HOME NURSING 



the back of the neck or over the stomach causes a sensa- 
tion of sleepiness, gentle rubbing is also soothing, avoid 
stimulants, such as tea or coffee late in the day, divert the 
mird from the subject which is keeping it active by trying 
to induce the patient to think of something else, or to do 
some active work, or take a walk before going to bed. If 
this condition becomes habitual a total change of air and 
scene will be the most effective means to help overcome the 
habit. 

A CHILL 

A chill may be the initial symptom of disease or the re- 
sult of nervous reaction from severe pain or nervousness. 
The blood vessels of the skin contract and thus a 
greater amount of blood is sent to the interior of the body 
which causes sensation of cold on the surface with shiver- 
ing of the body and chattering of _the teeth more or less 
violent according to the intensity of the chill. 

Treatment. Lay the patient down, apply hot water 
bags, wrap up in blankets and give hot drinks. Take the 
temperature after the chill, and again in an hour: a high 
fever rarely follows in a case of chill arising from nervous- 
ness but with those from other causes the temperature will 
be very high and this should be watched carefully. 

HIVES 

Hives is an eruption that comes on the body in the 
form of pale red circles from % to 1 inch in diameter, 
which are very itchy. The cause may be from indigestion, 
constipation or from eating certain foods. 

Treatment. Give a laxative, preferably magnesia in 
this case, and for the relief of the itchiness apply car- 
bolized vaseline or camphor ice or menthol. Give water 
freely and a very light diet for a few days. 

CATARRHAL COLD IN THE HEAD 

This is an inflammation of the mucous membrance of 
the nose and the throat and often of the eyes as well with 



MINOR ILLNESSES AND DISORDERS 139 



a very free discbarge of mucous which may extend to the 
trachea or even bronchial tubes. 

Treatment. Give the patient a warm bath and a laxa- 
tive and keep in bed for a few days. Some relief is ob- 
tained by inhaling steam from a solution of benzoin (1 
tsp. to a pt. of water — or the same amount of pulverized 
camphor) and for this treatment a paper cone can be made 
of newspaper or brown paper to extend from the kettle to 
the patient. Gargling the throat with an astringent; such 
as lemon juice, glycerine, water and soda or very hot saline 
solution may provide relief. 

Give fluid drinks such as hot lemonade and plenty of 
water. To allay irritation of the surface of the throat, 
which frequently causes coughing, give the white of egg 
with a little lemon juice in it. Apply a mustard paste, or 
a flaxseed poultice over the chest and throat or rub on 
camphorated oil, or turpentine and oil in equal parts. 
(This treatment must be stopped before the skin is too 
much irritated.) Give a light but nourishing diet. Care 
is needed to build up the system afterwards to prevent a 
repetition of the same condition. 

SORE THROAT 

It is always important to take precautions in regard to 
a sore throat as it may indicate so many serious conditions; 
look into the throat and see if there are evidences of 
spots or membrane on it or if it is very red. It is safer to 
isolate any one with a sore throat until sure that it is not 
of an infectious nature. 

Treatment. For immediate relief use a very hot 
saline solution gargle, or an irrigation of the same (for 
method see page 103) or an astringent gargle or spray 
might be substituted. Either hot applications (poultices 
or fomentations) or ice cold applications may be used on 
the outside of the throat and in many cases afford speedy 
relief. Give a laxative and watch the temperature closely 
and allow very light diet. 



CHAPTER XVIII 



EMERGENCIES 

Emergency treatment is chiefly given : 

1. To prevent further injury to the affected part by 
handling the patient carefully. 

2. To save undue effort of the heart which suffers from 
extra strain on account of the general shock of the injury. 

3. To give all the comfort and ease and relief possible 
to the patient. 

RULES FOR EMERGENCIES 

1. Keep calm. 

2. Have the patient lie down, admit fresh air, loosen 
clothing, and make the patient comfortable until the physi- 
cian comes. 

3. Give simple stimulants, such as a drink of water, a 
cool breeze supplied by fanning, or external heat. 

4. When sending a message to a physician, state the 
nature of the case clearly. 

SHOCK 

In connection with all injuries there is a more or less 
serious depression of the nervous system which frequently 
affects such vital parts as the heart. This condition is 
spoken of as shock, sometimes prostration, and may be 
recognized by extreme pallor, feeling of cold, clammy skin, 
feeble pulse and shallow breathing. 

Treatment. Eemove the cause if apparent (such as 
hemorrhage) ; heat the body by covering the patient, ap- 
plying hot water bags and giving hot drinks — coffee, tea, 
etc. Lay patient on the back with the head low. Admit 

140 



EMERGENCIES 



141 



fresh air and loosen any constricting clothing at the neck. 
Stimulate by inhaling smelling salts or ammonia, or by 
giving aromatic spirits of ammonia, half a teaspoonful in 
a little water. 

FAINTING 

Cause. Loss of blood to the brain due to some dis- 
turbance in the circulation. 

Symptoms. White face, feeble pulse, shallow breath- 
ing, giddiness to unconsciousness. 

Treatment. Send blood to the brain by placing the 
patient in a lying-down position, and if possible with the 
head lower than the heart or if unable to do this, bend 
the head down over the knees. Provide free circulation of 
fresh air for the effect of oxygen on the blood — make a 
crowd stand aside — loosen any tight clothing — espe- 
cially at the neck. Smelling salts may be used for inhal- 
ing — holding it so as not to spill the fluid. Ammonia 
or aromatic spirits of ammonia can be sprinkled on a hand- 
kerchief and held to the nose likewise. When the patient 
becomes conscious, a stimulant may be given of aromatic 
spirits of ammonia (half a teaspoonful to 1 ounce of 
water), or alcohol (such as whiskey: 1-2 tablespoonfuls to 
% as much hot water or a little sherry). For some time 
afterwards, keep the patient lying down, quiet and warm. 

APOPLEXY 

Cause. Pressure on some part of the brain caused 
by hemorrhage. 

Symptoms. Unconsciousness, flushed face, difficult 
noisy breathing, and one or both pupils of the eyes may be 
dilated. This condition is followed by paralysis of the 
muscles, either slight or severe. 

Treatment. Elevate the head and chest, holding the 
head steady while doing this ; loosen clothing at the neck ; 
apply ice or cold to the head and warmth to the extremi- 
ties. Do not move the patient unless absolutely necessary 
and do not give alcoholic stimulants in this case. 



142 



PRACTICAL HOME NURSING 



QUESTIONS 

What is the cause of fainting I 

What would you do for the patient ? 

How does position affect this condition ? 

Mention stimulants that could be used for inhaling. 

What is the cause of apoplexy ( 

Give symptoms. 

How treat the patient — why elevate the head ? 
What condition follows an attack of apoplexy ? 

FRACTURES 

A fracture is the breaking of a bone. The chief kinds 
are Simple and Compound. 

A simple fracture is where the bone is broken and 
no wound leads to the surface. 

A compound fracture is where the bone is broken and 
the air penetrates to the broken bone. The latter is always 
serious from the danger of infection being carried into the 
bone and tissues. 

The emergency treatment of fractures is largely to pre- 
vent a simple one from becoming compound, by careful 
handling of the part. 

Symptoms. Loss of power of the part, pain (from 
injury to the nerve), swelling (from fluid in the tissues), 
and discoloration (from the escape of blood from the 
small blood vessels). 

Appliances for the treatment of fractures are splints and 
bandages. For the former can be utilized a flat piece of 
wood, a walking stick or umbrella, a folded newspaper or 
cardboard, in fact anything that is firm and long enough 
to reach beyond the joints above and below the break. 
These should be padded with whatever is available. For 
bandages — handkerchiefs, ties, torn up clothing or regu- 
lar bandages (if available) can be used. 

Treatment. For a simple fracture. Keep the in- 
jured part quiet and slightly elevated with a support un- 



EMERGENCIES 



143 



derneath. Apply cold over the part and lay the patient 
down on account of shock. 

For a compound fracture, the same treatment applies 
except that in addition it is necessary to cleanse the wound 
and to place a sterile dressing over it. (See page 51.) 

For simple fracture of the lower extremity. Place 
the patient on the back and put a splint or support under- 
neath the injured leg, extending beyond the adjacent 

joints and tie this on with a bandage. Support may also 
be provided on either side of the fracture. Lacking 
splints, tie the legs together at points beyond the joints 
adjacent to the break if it is necessary to move the patient. 
Always apply cold over the part if practical in order to 
reduce the tendency to inflammation. 

For fracture of the arm: Place the injured part on a 
pillow and apply cold over the surface. If it is 
necessary to move the patient, bandage on a splint under- 
neath the fractured part, extending above and below the 
adjacent joints. Adjust a sling to give additional support 
and keep the arm quiet. If the injury is in the forearm, 
the elbow is encased in the sling, while if in the upper 
arm, the sling extends only to the elbow and does not 
encase it. 

For a fractured collar bone: Place a pad under the 

arm on the injured side — flex the arm and have the 
fingers nearly touching the opposite collar bone, and band- 
age the elbow close to the body to keep the shoulder 
joint immovable. 

For broken ribs: Place a bandage, such as a folded 
towel, closely around the chest, and pin firmly to keep the 
muscles between the ribs quiet. 

SPRAINS 

A sprain is the tearing or injuring of the ligaments 
around a joint and this becomes swollen and discolored 



144 PRACTICAL HOME NURSING 



due to the hemorrhage of the smaller blood vessels into the 
deeper tissues, and any movement of the muscles pains 
the joint. 

Treatment of a sprained ankle. Slightly elevate the 
ankle and support it comfortably; apply either heat or 
cold continuously over the joint for 1 or 2 hours, then 
bandage firmly to support it and to keep the muscles quiet 
around the joint. 

If the ankle is sprained while out of doors and the 
patient is obliged to walk home, it would be best to keep 
the shoe on and bandage tightly outside of that with what- 
ever is available (a handkerchief or tie), giving the above 
treatment as soon as possible. A sprained wrist or knee 
would be treated in same way. 

STRAINS 

A strain is an injury to or a twisting of a muscle. 

Symptoms: Sharp pain in the muscles when moving 
them, probably swelling of the part. 

Treatment : Place the patient in the most comfortable 
position, with a support, such as a pillow, under the in- 
jured part, and apply heat (hot water bottles or hot fomen- 
tations — see page 106) over the strained muscle. 

DISLOCATIONS 

A dislocation is where the ball at the end of a bone is 
out of its socket, causing deformity and swelling. 

Treatment for dislocated finger. Apply cold over 
the joint and if a physician is not available an attempt 
can be made to replace the dislocation by pulling the finger 
hard and straight out beyond the ridge of the socket, letting 
it snap back into place. If this is accomplished, bandage it 
securely and keep cold over the joint for some time. 

For a dislocation of the jaw, under like circumstances, 
wrap both thumbs in cloth — then place them in the pa- 
tient's mouth, resting on the lower teeth while the fingers 



EMERGENCIES 



145 



grasp the jaw outside. Make pressure downward and 
backward, quickly letting go as it slides into the socket. 
Bandage the jaw to keep it in place. 

For dislocations of other joints, support the part and 
keep cold applied until a surgeon arrives. Do not attempt 
treatment. 

QUESTIONS 

What is a fracture ? 

State difference between a simple and compound fracture. 
How treat simple fracture until the surgeon's arrival. 
What can be done to prevent a simple fracture from becom- 
ing compound ? 
Mention important points in adjusting a sling. 
How is new bone formed ? 
What is a sprain ? 

How could you relieve the pain in a sprained ankle ? 
What is a strain — how relieve ? 

HEMORRHAGES 

EXTERNAL HEMORRHAGE 
Cause : The escape of blood from a blood vessel. 
Symptoms: Blood from the wound, pallor, feeble 
pulse, and, if severe, general prostration. 

Treatment: Elevate the part, lay patient down, 
and apply pressure on the main artery between 
the wound and the heart. This can be done either with 
the fingers — a ligature — or a tight bandage which can 
hold a pad or some other pressure over the artery. A 
tourniquet may be used if necessary (see page 179), but 
this should not be left on longer than half an hour and 
loosened very gradually. In hemorrhage from veins — 
pressure is made below the wound. In hemorrhage from 
capillaries — pressure is made over the wound. Give 
no alcoholic stimulants in cases of hemorrhage. 



146 



PRACTICAL HOME NURSING 



MAIN ARTERIES THAT MAY BE PRESSED 
TO CONTROL HEMORRHAGE 

HEAD 

For internal hemorrhage — Carotid artery, in the 
neck, on either side, at a point on a level with the chin. 

For external hemorrhage — Carotid artery, in front 
of the ear. Temporal artery, over the temporal bone. 

UPPER EXTREMITY 
Upper Arm — Subclavian artery, under the clavicle 
bone, pressing from above down. Brachial artery, on the 
inner side of the upper arm. 

Lower Arm — Brachial artery or applying pressure 
by placing a pad in the bend of the elbow and bandaging 
the lower and upper arm together. 

LOWER EXTREMITY 

Thigh — Femoral artery, in the groin midway be- 
tween the hip and the center of the body, or along the 
inner side of the upper leg. 

Lower leg — Popliteal artery, under the knee, apply- 
ing pressure with a pad held in place by bending the leg 
back and bandaging to the thigh. 

INTERNAL HEMORRHAGE 
Cause : Escape of blood from a blood vessel. 
Symptoms : Low temperature, weak, rapid pulse, pal- 
lor, thirst and prostration. 

Treatment: Lay patient down, raise the affected 
part if practical. Keep absolutely quiet, with ice on the 
part. Give no alcoholic stimulant and treat prostration 
by external heat. 

NOSE BLEED 
Treatment: Raise the head and, if easier to keep 



EMERGENCIES 



147 



patient quiet, lay lier down with the head raised on a pillow 
and turned to one side so that the blood may trickle easily 
into a basin. Apply ice over the nose. Pressure can be 
made on the artery leading to the nose by placing a pad 
under the upper lip, close to the outer angle of the nostril. 
If necessary, use an astringent; for this, vinegar, diluted 
with equal parts of water, may be sprayed on or brushed 
over the surface inside of the nostril or a piece of cotton 
saturated with alum placed inside the nostril. 

HEMORRHAGE OF THE THROAT 
Symptoms : Bright red blood from the mouth. 
Treatment: Keep the head raised and supported to 

keep it quiet, with cold on the outside of the throat. An 

astringent spray may be used. 

HEMORRHAGE OF THE LUNGS 
Symptoms: Blood filled with air bubbles, from the 
mouth (this shows the interchange of air and blood in 
the lungs). This hemorrhage usually follows the effort 
of coughing. 

Treatment : Keep patient lying down and quiet, with 
head and chest slightly raised. Ice can be applied to 
the throat and chest and heat to the body. Small pieces of 
cracked ice given by mouth relieve thirst. 

HEMORRHAGE OF THE STOMACH 
Symptoms : Blood vomited, dark in color, mixed with 

food and juices (often resembles coffee grounds). 

Treatment: Have patient lying down quiet, with 

ice on the pit of the stomach. 

HEMORRHAGE OF INTESTINES 
Symptoms: Blood from the rectum resembling that 
of a hemorrhage of the stomach. 



148 PRACTICAL HOME NURSING 



Treatment : Keep patient quiet and lying down with 

the foot of the bed raised, and ice on the abdomen. 

HEMORRHAGE OF THE UTERUS 

Symptoms : Blood from the vagina. 

Treatment Keep patient lying down, move for no 
reason whatever, raise the foot of the bed. Tie the knees 
together to prevent the patient from moving the legs. 

QUESTIONS 

What is hemorrhage ? 

What are the means used to control hemorrhage ? 
How may pressure be applied ? 

What quality in blood assists in stopping hemorrhage? 
How would you control a hemorrhage from the upper arm ? 
How distinguish between bleeding from the lungs and the 
stomach ? 

What is the difference in the treatment ? 
How arrest hemorrhage from the nose ? 
What could be done to check a hemorrhage from the 
uterus ? 

BURNS AND SCALDS 

A burn is an injury to tissue caused by dry heat, while 
a scald is a similar injury caused by moist heat. 

1. The effect of a burn may be a mere reddening of the 
skin, or 

2. The formation of blisters on it. 

3. The deeper tissues may be involved. 

If clothing adheres to a burned surface, it must be 
most carefully removed to prevent further injury. Cut 
it away from around the part and saturate with oil or 
water any clothing that is directly over the burn, as this 
makes its removal easier. 

Methods of Treatment : Cover the burn to exclude 
the air, and thus ease the pain. 

1. Place the burned part in a solution of water and bi- 



EMERGENCIES 



149 



carbonate of soda (baking soda), 1 oz. to a pint of water; 
or, if there is no soda available, use water alone at the 
temperature of the body (98°). This excludes the air 
and gives temporary relief. 

2. Place a wet dressing of above bicarbonate solution 
over the injured part and keep it wet. 

3. A lotion of sweet oil and lime water (equal parts 
shaken together) may be used as a dressing — or carron 
oil, which is linseed oil and lime vater in equal parts. 
Vaseline and goda combined or boracic ointment are like- 
wise valuable. Picric acid gauze can be obtained and 
placed directly over the burn. Another treatment, largely 
used at the present time, is the application of a form of 
parafin which is placed over the burn, where it hardens 
and forms a protective covering. Always bandage the 
dressing on a burn without any pressure, very lightly 
and keep the part supported comfortably. 

Patients suffer from shock very much in case of burns 
for which treatment may be given as described (see page 
140 N 

Sunburn is really a mild burn. 

Treatment: Use for relief a weak solution of baking 
soda and water, or apply oil and soda, or white of egg 
spread over the burn, or talcum powder, and keep it cov- 
ered. 

FIRE 

If clothes catch on fire (self), try to keep your presence 
of mind. Lie down and press the burning parts to the 

floor to prevent a draught and thus put out the fire; or 
if there is a woolen article or wet cloth handy, pull this 
closely around yourself, but do not run for a wrap as 
this increases the danger of flame. 

If the clothes of another person catch fire, do the same 
thing to them, and if possible to secure a rug or blanket 
or a wet sheet, wrap it around them from the head down 



150 



PRACTICAL HOME NURSING 



to prevent the fire from reaching the hair and face and 
the inhaling of the flame. 

OVERCOME BY SMOKE 

If a patient is overcome by smoke inhaled, get them at 
once into the fresh air, make a crowd (if any) stand back, 
give artificial respiration and stimulants. 

FROST BITE 

When exposed to severe cold, such parts of the body as 
the ears, nose, feet and fingers are apt to freeze. The 
frozen part loses sensation, becomes waxy white and later 
is congested and a dark blue color. 

Treatment: Do not take patient into a warm 
room but keep in cool place. Rub the frostbitten part 
gently with a cold cloth or with snow, and later with the 
hand or a towel. Or when possible, as in the case of a 
frozen foot or hand, place it in cold water and rub while 
there to restore the circulation safely. When circulation 
is fully restored, have the patient still kept in a cool room 
for some time as the return to heat must be very gradual. 
After this, a soothing ointment as for a burn may be used 
on the surface. 

QUESTIONS 

What aid could you give to a person whose clothes were 
on fire? 

What could you do if your own clothes were on fire ? 
How remove clothing from a burned surface ? 
What is a burn ? 

What is the first thing to do to relieve the pain of a burn ? 

What simple dressings may be applied ? 

What is the great danger attending a severe burn ? 

ARTIFICIAL RESPIRATION 
Schafer method : Lay the patient on chest, with head 
turned to one side in order to keep the nose and mouth 



EMERGENCIES 



151 



off the ground. Have arms extended over the head. 
Then kneel alongside or astride of patient facing the head 
and, placing both your hands with palms down on the 
lower ribs, one on either side of the spine, press steadily 
downward and forward, bringing the weight of your body 
to bear on your hands while you swing your body forward, 
thus pressing the air out of the patient's lungs. This pro- 
duces expiration. Draw back your body somewhat more 
rapidly and relax the pressure without removing your 
hands. This produces inspiration. Continue these 
movements alternately until respiration is restored or a 
doctor pronounces life to be extinct. 

DROWNING 

As quickly as possible loosen the patient's clothing and 
clear the mouth and throat by wiping it out with a hand- 
kerchief wound around your finger. Place patient face 
downward with a pad below the chest, or, in place of a pad, 
press from underneath with your hands on the pit of the 
stomach; this movement is made to help free the passage 
from water. Then give artificial respiration as described 
above until breathing is restored. 

Surround the patient with heat as soon as it can be 
obtained and also give stimulation. 

GAS POISONING 
Give fresh air in abundance. Keep the patient lying 
down. Apply external heat and stimulation and, if neces- 
sary, artificial respiration. For some days afterwards, the 
patient should take a quantity of fluid to help eliminate 
the poison. 

ELECTRIC SHOCK 

If necessary to remove patient from contact with a live 
wire protect your hands with something which will resist 
the current, such as rubber, dry silk, dry cloth, dry wood or 



152 PRACTICAL HOME NURSING 



straw, or newspaper, or else drag the patient away with a 
rope or push with a stick. 

Treatment for insensibility: Lay patient down, 
loosen clothing, give fresh air, keep slapping the face and 
chest with wet cloths and give artificial respiration. 
After consciousness is restored, treat the burns, if there 
are any. The same treatment applies in shock from light- 
ning. 

SUN STROKE OR HEAT STROKE 
Cause : Exposure to excessive heat or to the sun's rays. 
Symptoms: High temperature, flushed face, faint- 
ness, difficulty in breathing. 

Treatment : Move patient to a cool place, loosen or 
remove most of clothing, fan vigorously, apply cold to the 
head and body. Give no alcoholic stimulants, but when 
the patient is able to swallow give cold water. 

HEAT EXHAUSTION OR COLLAPSE FROM 
HEAT 

Symptoms: Weakness (without unconsciousness), 
pulse weak and rapid, breathing shallow. 

Treatment: Put patient in a cool place, give stimu- 
lants sucb as tea, coffee, aromatic spirits of ammonia, and 
apply heat to the extremities. 

ACUTE INDIGESTION 

Cause : Undigested food, cold, or from eating heartily 
when overtired. 

Symptoms: Acute pain in stomach or abdomen, or 
both. 

Treatment: Give a strong emetic of mustard, or salt 
and water, and when the stomach is quieted, give a dose 
of castor oil. Secure a free action from the bowels by an 
enema at once. Give hot water with a little soda in it 
to counteract the acidity of the stomach. Rest, warmth 
are helpful and the diet, following this, should consist of 
the simplest sort of food, such as beef tea, gruels, etc. 



EMERGENCIES 



153 



QUESTIONS 

What is the first thing to do in case of drowning? 
Describe Scbafer method of artificial respiration. 
State treatment for patient overcome by gas or smoke. 
Give symptoms of sunstroke. 
What should be done immediately ? 

Give treatment for patient suffering from heat exhaustion. 
What symptoms would there be in evidence with acute 

indigestion ? 
How relieve this condition ? 

FOREIGN BODY IN THE NOSE 

Make pressure on the opposite nostril and have patient 
take a deep breath through the mouth and then close it. 
Thus the air may force the obstacle out. Or, while press- 
ing on the opposite nostril, blow the nose hard or induce 
sneezing by tickling the inside of the nostril, or having a 
little pepper in the air. 

FOREIGN BODY IN THE EAR 

If it is a hard substance, hold the head down on the 
affected side to prevent its going farther in, and unless it 
falls out easily, seek medical aid, as it is never safe to put 
an instrument in the ear. 

If there is an insect in the ear, pull the ear upward 
and backward and drop in warm oil, or syringe it with 
warm water, being careful not to close the opening into 
the ear with the end of the syringe. 

FOREIGN BODY IN THE EYE 
Pull down lower lid and if the substance can be seen 
remove it with the pointed corner of a handkerchief. 
When it is beneath the upper lid, draw the upper lid out 
and push the lower lid up under it. The substance may 
then attach itself to the eyelashes on the lower lid. When 



154 PRACTICAL HOME NURSING 



any foreign body is firmly attached in the eyeball, place 

wet gauze or a wet handkerchief loosely over the eye and 
hold it on with a very light bandage until patient can be 
taken to a physician. 

It is always safe and generally successful to try to 
remove a foreign body by washing the eye out carefully 
(using weak salt and water, boracic acid solution or plain 
water) and as the fluid goes over the surface, hold the lid 
out from the eye and direct the patient to move the eyeball 
up and down. 

FOREIGN BODY IN THE THROAT 

Insert your finger along the inside of the cheek as far 
back as possible, then make an outward motion with the 
finger to dislodge the obstacle. Bend patient's head for- 
ward and slap between the shoulders hard to force a cough. 
In the case of a very small child hold up by feet with head 
down and slap between the shoulders. 

FOREIGN BODY SWALLOWED 

Do not cause vomiting by an emetic or give a laxative, 
but give starchy food (such as potatoes, bread, oatmeal, 
cornmeal mush) in which the substance will more likely 
pass safely through and out of the body. Observe the 
stools until the object is passed. 

WASP STINGS AND INSECT BITES 

Apply a strong alkali to counteract the strong acid of 
the sting, such as ammonia, soda, lime water, or menthol, 
if indoors. If out of doors, apply mud as this contains a 
strong alkali. 

RELIEF FROM FLIES AND MOSQUITOES 

Pour into an atomizer half a teaspoonful of lavender 
oil. Add to this as much alcohol as will make a saturated 
solution. Use as a spray. Sweet clover hung about the 



EMERGENCIES 



155 



room will banish flies and mosquitoes. The drier the 
clover becomes, the more effectual it is. 

QUESTIONS 

If a foreign body is swallowed what should be done about 
it? 

What would you do if lime was in the eye ? 

Xame fluids that could be used to wash out the eyes. 

How would you treat if a foreign body was under the 

upper lid ? 
If firm in the eyeball what could be done ? 
How try to remove an insect from the ear? 
Would you make any effort to remove any hard substance % 
How relieve earache % 

HYSTERIA 

Cause: Uncontrolled nerves often due to overfatigue, 
or nerve strain, or habitual lack of self-control. 

Symptoms: In appearance, the symptoms are rather 
negative. The body is warm, the color and pulse normal. 
The patient acts in an uncontrolled way, sometimes grind- 
ing the teeth, or thrashing around, and alternately weeping 
and laughing. 

Treatment: Leave unnoticed as much as possible in 
order that the patient may get control of herself. Speak 
sharply to attract attention and divert the mind. 
Sprinkle cold water or apply a cold sponge to the f^ce. 
A warm bath often gives immediate relief in such cases, 
and complete rest is required afterwards as the patient has 
had a certain amount of strain, both physical and nervous. 

EPILEPTIC FIT 
Cause : A disease of the nervous system. 
Symptoms: Usually a shrill cry accompanied by con- 
vulsions and unconsciousness, throwing the limbs about, 



156 PRACTICAL HOME NURSING 



while the whole body twitches violently. In a few mo- 
ments the patient recovers consciousness but is drowsy and 
usually sleeps. 

Treatment: Prevent patient from injuring himself 
when twitching. Place a hard substance, such as a pen- 
cil or even a rolled up handkerchief, between the back 
teeth to prevent biting the tongue, loosen the clothing 
around the neck, place a pad or pillow beneath the head 
and remove any obstacles which the patient might knock 
against. 

QUESTIONS 

What is the usual cause of hysteria ? 

How could you help a patient to regain control ? 

What after treatment is necessary ? 

Describe an attack of epilepsy. 

What special care must be taken in treating such a condi- 
tion ? 

POISONING 

In case of poisoning send for a physician at once, stating 
the case, and if possible, the name of the poison. Poisons 
either irritate or deaden sensibilities. 

Irritant poisons: Irritant poisoning is caused by 
strong acids, alkalies, or chemicals. 

Symptoms : Severe pain in the stomach and abdomen, 
vomiting, diarrhoea and extreme prostration — the severity 
of the prostration depending upon the poison. 

Treatment. To neutralize the poison give the anti- 
dote if known. If the definite antidote is not known, it 
is well to remember that if an acid has been taken to give 
an alkali and if a strong alkali to give an acid. See page 
120. 

If the poison has been taken by mouth, give an emetic 
(except where the poison has burned the lining of the 
mouth) of salt and water, 1 tbsp. to a glass; and persist 
in causing free vomiting. Give something to soothe the 



EMERGENCIES 



157 



surface, such as white of egg or milk or cereal gruel. 

When the mouth has been burned give the soothing 
drink instead of the emetic. Treat the shock by inhaling 
ammonia or giving coffee, tea, or alcohol (by enema, if 
necessary), and by external heat. 

Narcotic poisoning. These dull the sensibilities and 
are usually caused by some form of opium. 

Opium poisoning. Symptoms: Drowsiness to un- 
consciousness ; contracted or very small pupils of the eyes 
(pin points) ; very slow breathing. 

Treatment : Is taken by mouth, wash out the stomach 
freely with emetic. It is more difficult in this case be- 
cause the patient only wants to be let alone. Use irritant 
emetics, such as mustard and water — 2 tsps. to a glass, 
or salt in the same proportion. Keep patient awake by 
walking about or by any practical means — such as flicking 
with wet towel particularly on the chest and face. Give 
stimulation by large quantities of black coffee or tea. 
Never give alcoholic stimulation in these cases as this 
tends to produce stupor. Apply artificial respiration, if 
necessary. 

Ptomaine poisoning. The cause is poisoning by food. 

Symptoms: Great prostration, severe pain in the ab- 
domen, vomiting, diarrhoea, very weak pulse, cold, clammy 
skin. 

Treatment. Wash out the stomach by salt and water 
emetic, followed by a dose of castor oil. Later, saline irri- 
gations by rectum are given. Stimulate by external heat, 
hot water bottles and blankets. 

QUESTIONS 

State the most important thing to do in case of poison 

being taken by mouth. 
What is an antidote ? 
What emetics could be used ? 



158 PRACTICAL HOME NURSING 



Give symptoms of irritant poisoning. 
Give treatment for such a ease. 
Give symptoms of opium poisoning. 

Give treatment. Why has the patient to be kept awake ? 

What is the most effective stimulant in this case ? 

What is meant by ptomaine poisoning? 

Give symptoms. How treated ? 

How treat the shock caused by poisoning? 

CONVULSIONS (OF CHILDREN) 

A convulsion is a spasm or an involuntary contraction 
of the muscles of the body caused often by indigestion, high 
fever, or it may be the initiation of some disease. 

Symptoms: Muscles contracted, face almost blue, in- 
sensibility, frothing at the mouth. 

Treatment: Place cold on the head.* Put the child 
in a hot bath registering 105° by a thermometer, but lack- 
ing the latter, test the heat by placing your elbow in the 
water (in the excitement of such a time, children have 
been burned by too hot water). Mustard may be added to 
the bath — 1 tablespoonful to a gallon of water. Keep in 
the bath 5 or 10 minutes or until muscles relax, then wrap 
in a warm blanket and keep cold at the head, and let the 
child sleep. Later give an enema and a dose of castor oil. 

Lacking the opportunity to give a bath, place cloths 
wrung out of hot water and mustard around the body, or 
put the feet in a basin of mustard and water. The mus- 
tard used should first be dissolved in cold water or put in a 
cheesecloth bag and squeezed into the water. Keep close 
track of the temperature after a convulsion and give noth- 
ing but water temporarily, followed by a very light diet 
for the next 24 hours. 

* Note: If the child is old enough to have teeth place 
something between them to prevent biting the tongue. 
(The rolled up corner of a handkerchief answers this pur- 
pose. ) 



EMERGENCIES 



159 



CROUP 

Croup is a contraction of the muscles at the entrance 
to the trachea from the throat. 

Symptoms: The chief symptoms are a noisy, 
" croupy " cough, difficulty of drawing air into the wind- 
pipe and straining for breath. 

There are two distinct sorts of croup ; one is the ordinary 
catarrhal croup and the other a membranous croup and 
very serious. The initial symptom — difficulty in breath- 
ing — is the same in both. Fortunately the latter is com- 
paratively rare but if a child shows symptoms of croup 
look in the throat immediately and see if there is any 
sign of membrane forming there. If so, report it to the 
physician at once. 

Treatment : Give an emetic of a teaspoonful of syrup 
of ipecac, a little alum on sugar, or one teaspoonful of 
melted vaseline. The finger can be put down the throat 
to induce vomiting. Place hot, moist cloths around the 
neck and down the middle of the chest, keeping a warm 
hot water bottle over them, or a flaxseed poultice can be 
applied there. 

Hot, moist air to breathe relaxes the muscles and may be 
provided by the following methods : 

1. Place a screen around the crib and cover the crib and 
screen with a sheet. If there is a croup kettle (this is a 
kettle with a long funnel spout) use this over some heating 
apparatus (alcohol or gas lamp) near the bed, being careful 
to avoid the danger of fire. Let the steam escape through 
the funnel under the sheet into the enclosed space. 
Lacking a croup kettle, use an ordinary kettle with a 
paper funnel or a child's bugle attached to the spout. 

2. Take the child to the bathroom and turn on the hot 
water so that the resulting steam may be breathed. 

3. Or take the child to the kitchen where a temporary 
bed may be made on a table or chairs near the stove, with 
an umbrella and sheet over it to provide an enclosed space. 



160 PRACTICAL HOME NURSING 



Have the steam from the kettle directed into this space by 
means of an improvised paper funnel. 

A mustard foot bath is sometimes very effective. 

Be careful in giving the treatments outlined above that 
the child does not take cold as the effort of difficult breath- 
ing causes excessive perspiration. Afterwards give a lax- 
ative. The diet for the next few days should be very 
light. 

QUESTIONS 

What are the causes of convulsions in children ? 

What are the signs ? 

Describe the treatment in detail. 

How prevent biting the tongue when in a convulsion if 
child is old enough to have teeth ? 

Why should a close watch be kept on the temperature after- 
wards ? 

What is the first thing to do if a child develops croup ? 

Is simple croup dangerous ? 

What can be done to relieve the condition % 

What after care is necessary ? 



CHAPTER XIX 



BANDAGES 

Bandages are used for various purposes: 

To give support to an injured part. 

To limit or restrict motion. 

To apply pressure. 

To hold dressings or splints in place. 

To control swelling of a part. 

They can be made of almost any material that is pliable 
enough to shape to the part: muslin, gauze, stockinet, 
flannel, rubber and also crepe paper. Those in most com- 
mon use are the 



Roller — usual lengths 5 to 7 yards, and 1 to 5 inches 
wide. These should be tightly rolled up before ap- 
plying. 




161 



162 



PRACTICAL HOME NURSING 



Triangular — made by folding or cutting a 40-inch 
square of material diagonally and can be used either 
spread out or folded into a wide or narrow band. 
These are used mainly in emergency work to retain 
dressings and splints. 



Fbw-tailed Bandage 



Four-tailed — represents a roller bandage about 6 or 
8 inches wide and 1 yard long, slit down from each 
end to about 6 inches from the center. 



FOUR-TAILED BANDAGE APPLIED 

Four-tailed bandages are principally used for the head 
and face, as well as for the knee and elbow. In general, 
to apply a bandage of this sort, place the center over the 
injured part and tie the ends securely together where they 
will most firmly hold the bandage in place. 

To apply a four-tailed bandage to the chin. Place 
the center of the bandage over the chin itself, bringing the 
two opposite lower ends to the top of the head where they 
are tied, and the two opposite upper ends to the back of the 
head and tied. 

For the forehead, or top of the head. Place the cen- 
ter of the bandage over the injury, with the two opposite, 
forward ends brought to the back of the neck and tied, and 
the two remaining ends brought beneath the chin and tied. 



BANDAGES 



163 



TRIANGULAR BANDAGE APPLIED 

Sling for arm and hand. Hold the arm in position, 
with the hand slightly raised. Slide the sling carefully 
up under the arm with the point at the elbow and the bias 
edge extending straight up and down on the uninjured 
side and over the shoulder. Carry up the lowest point 
of the bias edge over the shoulder of the injured side. 
Pin both ends together to the coat at the back or else tie 
in a knot at the side of the neck — a pad should be placed 
under the knot. (These methods of fastening prevent 
strain on the neck.) Adjust the point of the sling at the 
elbow and secure with a pin. If the sling is not large 
enough to reach around the back of the neck, each point 
can be pinned to the coat at the shoulders. If not neces- 
sary to encase the elbow, adjust the sling in the same way, 
except the point which should be turned back on itself and 
pinned to the under side of the sling just above the flexed 
arm. 

Head bandage. To protect a dressing on the head, 
fold a hem two inches deep along the bias edge of the 
triangle and place this around the forehead with the point 
hanging down the back. Draw the rest of the triangle into 
folds close to the sides of the head, cross the ends at the 
back, bringing them around to the forehead where they are 
tied. Bring the pointed end up and over the crossed 
bandage at the back and pin securely. 

Hand bandage. To retain a dressing on the hand, 
place a triangular bandage spread out under the hand with 
the fingers directed toward the point. Carry this point 
over the back of the hand to the wrist. Draw the rest of 
the bandage into folds at either side and cross it so that 
the ends can be tied around the wrist. Pin the point down 
over this. 

Foot bandage. For dressings on the foot, use the same 
method as for hands, fastening at the ankle instead of at 
the wrist. 



164 PRACTICAL HOME NURSING 



,H — ' n 

* \ ' s \ 

Tndngulor Bandage v . 
' Folded/ 



A triangle folded into bands can also be used for the 
eye, ear and jaw, and over any joint. 

ROLLER BANDAGES 

These are the most important and are used to fix and 
retain dressings and splints, to prevent and control swell- 
ing, and to prevent undue pressure on any part. 

Suggestions for efficiency in roller bandaging. 

Keep the bandage well rolled up with the roll upwards. 

Leave an even space between each turn of the ban- 
dage — usually from % to V 3 the width of the 
bandage. The evenness of these spaces allows for 
the same amount of bandage on each part and helps 
to equalize the pressure. 

Bandage from below upwards, that is, away from the 
extremity. 

Make the firmness suitable to the need of that par- 
ticular bandage. 

Prevent pressure sores by placing padding of cotton 
or some soft material at points where the pressure 
might be felt, that is, at the ending point of ban- 
dages or at such places as the edge of the armpit, 
or, in the case of triangular bandages, under the 
knots. 





Sling for arm. 




Roller bandage for broken collar-bone. 



BANDAGES 



165 




Figure of eight bandage. 



Spiral bandage is a circular turn around any part, 
either straight around or slanted upward usually with an 
even space between each turn. 

Figure of eight is a turn of bandage slanting up and 



166 PRACTICAL HOME NURSING 

another turn slanting down, forming a V with spaces be- 
tween each turn. 

Spiral reverse is made by turning the bandage over on 
itself or reversing the downward stroke to make it fit the 
part. 

Spica bandage means a figure of eight bandage that con- 
nects an extremity with the trunk. 



BANDAGES 167 

ROLLER BANDAGES APPLIED 

In the following diagrams each consecutive move- 
ment is indicated by the numbered sentence. 

Finger bandage — (Tip of finger is to be uncovered.) 

Roller 1 inch wide. 

1. Make a turn around the finger about half way up. 

2. Carry bandage down and make a turn around the 
finger y 2 inch from the tip. 

3. Make figure of eight or spiral turns until the finger 
is covered. 

4. Then carry the bandage up over the hand and 
around the wrist. 

5. Down over the hand and around the base of finger. 

6. Repeat up over hand and fasten around the wrist. 

Finger bandage — (Tip of finger to be covered.) 

Roller 1 inch wide. 

1. From the base of the finger take one fold down and 
over the tip. 

2. Return to same point underneath finger. 

3. Repeat twice, making the fold extend wider each 
time at the tip. 

4. Then make one fold around, half an inch from the 
tip. 

5. Continue to bandage the finger as described above. 



168 PRACTICAL HOME NURSING 

Spica for the thumb — 

Roller 1 inch wide. 

1. Make a turn around the wrist. 

2. Carry bandage down to the tip of the thumb and 
around it. 

3. Bring it up the thumb with spiral or figure of eight 
turns to half way above the first joint. 

4. Then carry the upward turn over the hand and 
around the wrist. 

5. Down the hand and around the thumb, making a 
figure of eight. 

6. Continue these turns until the joint is covered and 
fasten around the wrist. 

Figure of eight bandage for knee or elbow — (To 

allow for easy movement of the joint.) 

Roller 2 to 2% inches wide. 

1. Take bandage around the center of the elbow joint. 

2. Then carry the bandage around from above with 
the lower edge of the bandage to the center of the 
elbow. 

3. Then from below take it in the same way with the 
upper edge of the bandage to the center of elbow. 

4. Repeat this until joint is covered, leaving a little 
space between each layer. (Usually there are 5 
turns in all for the elbow and 7 or 9 for the knee. ) 



BANDAGES 169 

Bandage for hand and arm — 

Roller 2 to 2% inches wide. 

1. Make a turn around the wrist to secure it. 

2. Carry the bandage down back of hand to joint of 
little finger. 

3. Then around the hand. 

4. Carry bandage up back of hand to wrist, making a 
figure of eight turn. 

5. Repeat these turns until the hand is covered. 

6. Make two spiral turns around wrist, leaving space 
between each. 

7. Then make spiral turns to the elbow. 

8. Reversing this on the downward strokes. 

9. Make elbow joint bandage as described above. 
10. Fasten with a turn above the elbow. 



170 PRACTICAL HOME NURSING 

Bandage for upper arm and spica for shoulder — 

Roller 2/4 to 3 inches wide. 

1. Make a turn above the elbow to secure it. 

2. Make spiral turns up arm until nearing shoulder 
joint. 

3. Reversing the downward stroke. 

4. To connect it with the body carry upward stroke of 
bandage across the back (for a right arm injury). 

5. And under the far arm. 

6. Returning it across the chest and around the arm. 

7. Continue processes 4, 5, 6 until the necessary cov- 
ering is provided. 

Note: For a left arm injury, the first upward 
stroke on the body would be across the chest, under 
the far arm and over the back before completing 
figure of eight turn around the arm. 



BANDAGES 171 

Bandage for foot and leg — 

Koller 2 to 2% inches wide. 

1. Make a turn around the ankle to secure bandage. 

2. Bring the bandage down front of foot to include the 
big toe joint. 

3. Carry it around the foot. 

4. Then bring it up over the front of foot and around 
back of the heel (leaving heel uncovered). 

5. Repeat these turns until foot is covered. 

6. Then make two or three circular turns around the 
ankle with a space between each. 

7. Make a spiral bandage up the leg to the knee. 

8. Reversing or turning the downward stroke of the 
bandage every time. 

9. Arrange knee bandage as described before in ban- 
dage for elbow or knee. 

10. Make two turns around the leg above the knee to 
faster the end of the bandage. 



172 PRACTICAL HOME NURSING 

Bandage for thigh and spica for hip — 

Roller 2/4 to 3 inches wide. 

1. Make two turns below the knee to secure the ban- 
dage. 

2. Arrange knee bandage as described before. 

3. Make* two turns above the knee around the thigh. 

4. Make spiral turns up the thigh, reversing each 
downward stroke until near the hip joint. 

5. To connect it with the body, carry upward stroke of 
bandage around the waist. 

6. Then bring the downward strokes around and under 
the leg, forming the same figure of eight. 

7. Repeat these turns until desired space is covered. 



BANDAGES 173 

Bandage to cover the heel or foot as for sprained 
ankle — 

Roller 2 to 2% inches wide. 

1. Make two turns of bandage around the ankle to 
secrre it. 

2. Bring it from the front around and over center of 
heel. 

3. Then bring bandage under heel from below with 
upper edge of bandage to center of heel. 

4. Then, under the heel, from above to center in the 
same way, overlapping each other a little at each 
turn. 

5. Repeat third and fourth processes, making five lay- 
ers around the heel. 

6. Bring bandage down front of foot to toe joint, in- 
cluding it. 

7. Then pass it under and once around the foot. 

8. Make figure of eight bandage up the foot and around 
back of heel (keeping it low) and down to same 
point on foot. 

9. Repeat until foot is covered. 

10. End bandage around ankle and fasten securely. 



174 PRACTICAL HOME NURSING 

Bellevue walking bandage — (This holds securely 
when a patient is obliged to walk with a bandage on.) 

Roller 2% to 3 inches wide. 

1. Make two turns around the ankle to secure the 
bandage. 

2. Bring it around and under the instep (this prevents 
it slipping up). 

3. Then around ankle twice, leaving a space between. 

4. Make rapid ascending turn to below the knee ( 1 or 2 
turns). 

5. Carry bandage around the leg below the knee. 

6. Make rapid descending turn to ankle and around it. 

7. Then figure of eight turns until leg is covered. 

8. Take bandage around below the knee only every 
second or third time that it is brought up. 

9. End the bandage around the leg below the knee and 
fasten securely. 



Roller bandage to cover one eye. 




Roller bandage for tbe ear. 



BANDAGES 175 

Clavicle or collar-bone bandage — 

Eoller 2 to 2% inches wide. 

1. Place pad in armpit (on injured side). 

2. Bend the elbow, having the fingers Dearly touching 
the opposite collar-bone. 

3. Start the bandage from middle of back and pin se- 
curely to coat. 

4. Bring it over the opposite shoulder (uninjured 
side). 

5. Then down to the outside of elbow and around it. 

6. Then up the injured side to outside edge of shoulder. 

7. Take it across the back. 

8. And under the arm (uninjured side). 

9. Then bring bandage across and over front of elbow 
joint and 

10. Continue it around to the back of the body and up to 
the opposite shoulder. 

11. Eepeat from process 5, making 2 turns across and 3 
around the elbow. 

12. End bandage in the back and fasten. 



176 PRACTICAL HOME NURSING 

Valpeau hammock bandage — (Particularly adapted 
for use with children. ) 

Flannel bandage 5 inches wide, 3 yards long. 
Muslin roller 2% inches wide. 

1. Place a pad in the arm pit (injured side). Bend 
the elbow and have fingers nearly touching opposite 
collar bone. 

2. Start at waist line in the back with the flannel band- 
age and bring it up over the shoulder (uninjured 
side). 

3. Carry it down in front to point of elbow (injured 
side), make a loop around the elbow. 

4. Bring it back up over shoulder (uninjured side) 
and down to waist line. 

5. Fasten there with pin and attach muslin bandage. 

6. With this muslin bandage make one turn around 
the waist. 

7. Make a second turn around the waist but this time 
take it over point of elbow. 

8. Bring it around the back to the front and diagonally 
up over the shoulder (injured side). 

9. Bring it down behind the arm, around elbow and 
up in front of arm to same shoulder. 

10. Then across back diagonally and around to the front 
and over point of elbow. 

11. Repeat processes 8, 9 and 10, until bandage reaches 
arm pit. 



Recurrent bandage for the scalp. 




Roller bandage for sprained ankle. 



BANDAGES 177 
Bandage for the eye — 

Holler iy 2 to 2 inches wide. 

1. Make two turns of bandage around forehead to se- 
cure it. 

2. On second turn carry bandage behind the head, low, 
almost to the neck. 

3. Then pass it forward under the ear on the injured 
side. 

4. Bring it up over the lower part of the eye to the fore- 
head. 

5. And across the opposite side of the head and down 
to the neck. 

6. Then bring it forward again under the ear and up 
over the eye a little higher, leaving a narrow space 
each time. 

7. Eepeat this until the eye is covered and end the 
bandage around the forehead. 

Bandage for ear — 

Roller 1% to 2 inches wide. 

1. Make a turn around the forehead. 

2. Bring bandage down from front of forehead to low- 
est point over the injured ear. 

3. Continue it around the head, keeping low at back. 

4. Bring it around the forehead to the center. 

5. Then pass it over the ear again, a little higher, leav- 
ing a narrow space each time. 

6. Repeat until ear is entirely covered, and end the 
bandage around the forehead. 



178 PRACTICAL HOME NURSING 

Recurrent bandage for the scalp — 

Roller l x /2 to 2 inches wide. 

1. Fasten two roller bandages together. 

2. Place the center of the bandage on the forehead. 

3. Carry both bandages around to the back of head. 

4. Passing one underneath the other. 

5. Carry the underneath one back across the middle 
of the scalp, to lower edge of the forehead. 

6. Carry the other bandage around the head, crossing 
over the former bandage at the forehead (thus hold- 
ing it firmly). 

7. Continue the circle to the back of the head. 

8. Carry the first bandage back over the scalp, alternat- 
ing on either side of the center, at each turn. 

9. Take the circular bandage across this each time to 
secure it. 

10. Repeat this process until the entire scalp is covered. 

11. Finish the bandage with a circular turn around the 
forehead. 



BANDAGES 179 

Tourniquet. 

(This enables very tight pressure to be made with a 
bandage in case of hemorrhage.) 

1. Tie a knot in a handkerchief (or some material). 

2. Place this knot on the artery between the wound and 
the heart (or use a pad or other hard substance in 
place of the knot). 

3. Tie the bandage over this pad and around the part 
with a square knot. 

4. Place pencil or stick through the knot. 

5. Twist until hemorrhage ceases. 

6. To hold the pencil firm, cross both ends of bandage. 

7. Take them up and underneath the pencil. 

8. Cross again on top and bring down beneath its 
pencil. 

9. Tie a secure knot. 

In removing, slip the pencil out steadily. 

Untwist the bandage very slowly, holding it firmly 

all time. 

A tourniquet should never be used unless absolutely nec- 
essary and should not be left on longer than half or three- 
quarters of an hour, as it is dangerous to cut off the blood 
supply to any part for too long a time. 



CHAPTER XX 



ENTERTAINMENT OF PATIENTS 

Perhaps no one responsibility in the care of the sick 
calls for more judgment or understanding of human nature 
than the entertaining of patients. All through average ill- 
ness, the mental and nervous attitude is, to a certain exteut, 
dependent upon the happiness of surroundings. There 
can be no rules laid down ; each person must be considered 
individually with personal likes and dislikes, but as the 
need arises, patients are usually willing to become inter- 
ested in something outside of themselves that will make the 
time pass happily and give them employment and courage. 
When very sick, physical weakness prevents effort of either 
mind or body and such patients should be protected from 
any well-meant efforts at diversion. But as strength in- 
creases and, particularly with chronic invalids, it is often 
wise to encourage them to do small things that they want 
to do for themselves, thus making them feel that they are 
not absolutely helpless. In fact, in caring for the really 
handicapped, crippled and helpless invalids, our greatest 
opportunity to alleviate this sense of helplessness lies in 
the suggestion of interesting occupation, suitable to their 
powers. 

There is frequently a mental depression following sick- 
ness and a tendency for the convalescent to hug lovingly 
his or her own ailments, and keeping the hands busy is a 
marvelous aid in overcoming this weakness. The needs 
of convalescents differ from those of other patients to some 
extent: more attention having to be paid to the condition 
of mind and encouragement given to them to take up natu- 
ral responsibilities gradually. On that word " gradually " 



ENTERTAINMENT OF PATIENTS 181 



hangs a great deal of the speed with which the usual 
strength will be regained. 

Convalescence really means getting back, step by step, 
to normal responsibilities and the further away a patient's 
mind can be directed from the idea of illness, so much 
quicker will the progress be. If overtired, patients be- 
come discouraged, irritable and depressed, all because they 
have done more than physical strength allows. Two steps 
forward and one step back is discouraging — rather one 
and a half steps forward and no overtiredness. 

Visitors are a great benefit when they bring in an out- 
side influence that is bright and encouraging, but they 
also handicap convalescents if they overtire, irritate or 
are too exacting. Some visitors are comforting and re- 
poseful and quietly assume the responsibility of the en- 
tertaining, but it is quite the reverse when a patient has 
to strive to talk to and interest a difficult person, and in- 
valids should be protected from those who leave them ex- 
hausted and nervous. One visitor at a time is less tax on 
the nerves than two or three. The visitor should be placed 
in a convenient position so that the patient may not be 
obliged to turn the head to catch the sound of the voice. 

Because you are in charge, you must not feel it necessary 
to keep the patient amused and diverted every second. 
Let her own inclinations have some weight in the matter. 
It is one of the greatest mistakes to schedule every minute 
of time. 

Don't over-entertain. If a patient wants to rest or 
do nothing, it is very trying to have some one suggest that 
the best thing to do is to get up and walk, or if wanting 
to read, to have gardening suggested instead. In other 
words the patient's inclinations, unless unwise, should be 
followed as closely as possible but when requiring guid- 
ance, your resources should be sufficient to meet the need 
with understanding. 



182 



PRACTICAL HOME NURSING 



Reading aloud to patients. One of the first things 
in entertaining patients is to read to them. It is some 
strain on their part to listen ; this can be lessened by re- 
membering to modulate the voice, and to throw it directly 
towards them ; to read clearly and not too long at one time. 
In reading the daily papers or magazines, make a good 
choice of subjects that will interest the individual and the 
same applies in discussing current events. Be interested 
in the things a patient likes to talk about, and cultivate 
his or her particular hobby. 

Be a good listener. Nothing takes the place of this. 
As illness usually prevents much contact with the world, 
it is helpful if you can bring new ideas and fresh inter- 
ests to the patient's mind. In fact it is a distinct duty to 
go away from your patient daily for a change of thought 
and scene, so that when you return the influence of this 
new interest, whatever it may be, will unconsciously help 
to encourage and to brighten the mind. 

The convalescence of old people is always a slower 
process than that of youth. They are likely to get de- 
pressed and discouraged and need to be urged to new in- 
terests more than younger people. They are so apt to 
feel that it doesn't matter whether they get well or not; 
that they wouldn't be missed ; that no one needs them. 
They are very lonely. Nurses of experience have often 
noticed this and how much happier such patients are if 
some occupation can be found for them. With the young, 
even if crippled, there is the hope of increased strength 
and that muscles will grow stronger bit by bit with patience 
and exercise. Convalescents have not the endurance to 
work continually at one thing and the need of change in 
occupation and frequent rest from work is not sufficiently 
realized. 

Suggestions for entertaining. Perhaps change of 



ENTERTAINMENT OF PATIENTS 183 



scene will provide more entertainment than anything else 
and provision should be made for as much open-air work 
as possible. 

The work of gardening implies a fairly strong person 
but the lighter part of this is quite possible, such as plant- 
ing seeds and watching them grow, watering and light 
weeding. This proves quite interesting to both adult and 
child, but the latter will have to be persuaded not to dig 
up the seeds each day to watch their progress. Notice the 
effect of work on a convalescent and see if the interest in- 
creases or if they just keep at it with tense nerves as a 
duty. If the latter is the case, try something else or lessen 
the time devoted to one particular thing, and have some 
other resource in mind to which you can direct their at- 
tention. 

It is often quite simple things and those which are at 
hand that amuse and interest. Many an invalid enjoys 
clearing out her desk drawer and looking over all sorts of 
things that have accumulated, and also arranging the flow- 
ers which gives a special interest in them, and even quite 
sick patients like to do this. 

To be able to play games of all sorts, including cards, is 
a talent that can be used to advantage if the patient is fond 
of that sort of thing, but play keenly and make them inter- 
ested. There are a number of amusing games for two, 
such as Chinese whist, Rummy, and always the standby 
of solitaire (for either one or two people) ; also cribbage, 
checkers, dominoes and puzzles of all sorts. 

Among other suggestions might be mentioned: making 
a scrap book with the patient, on any subject that inter- 
ests; all sorts of clay modeling; stenciling, coloring pic- 
tures; making knots; carving leather for bags or book 
covers; knitting, crocheting and making baskets either of 
reed or raffia or various things of crepe paper (flowers, 
baskets, etc.). In arranging occupations, it is important 
to gauge the strength of the patient and where the eyes 



184 PRACTICAL HOME NURSING 



are not very strong to choose the coarser patterns in any 
work, and in making articles, such as a basket or knitting 
a sock, encourage the worker to have a definite plan for 
its use. If some personal interest can be connected with 
it, so much the better. 

Entertaining convalescent children. To meet the need 
during a child's convalescence, it is equally necessary to 
prevent their being overtired and overentertained as in 
the case of adults. Do not give too many toys at one time. 
Let the child get all the diversion he can from one and 
when tired of that, take it away and give another. A 
child will play with much less nerve strain when he is 
evolving things himself than when closely observing what 
another does. A little boy when he was sick received 
numbers of beautiful toys and one was a mechanical toy 
in a yellow cardboard box. The toy interested him a few 
minutes; the box for two weeks, for out of the latter he 
made all sorts of things with the help of some string, empty 
spools, imagination and suggestions from the nurse. One 
day it was a cart, another time a stable and just because 
he had designed and planned it himself, it became very 
precious to him. 

Children become overtired if read to for a long time. 
They will ask to have the reading continued but they don't 
realize the strain of listening and are none the less over- 
tired in consequence. 

In convalescence a child's eyes should be carefully 
guarded and no close reading or fine work of any sort al- 
lowed no matter what the illness has been. 

Children like to feel that a grown person understands 
and sympathizes with their desires, but they play more 
naturally when left to themselves and their own devices. 

Some simple suggestions are : sailing boats in a basin 
or bathtub; making soap bubbles from a simple clay pipe; 
cutting paper dolls and dolls' furniture; making toys of 



ENTERTAINMENT OF PATIENTS 185 



cardboard boxes or flowers out of tissue paper ; rabbits 
out of handkerchiefs ; studying birds and trees and flowers ; 
planning little gardens; sewing dolls' clothes and knitting 
for them ; modeling in clay ; putting picture puzzles to- 
gether ; playing with mechanical toys ; making scrap 
books of jokes or poetry clipped from magazines, or of ad- 
vertisements and picture postals; coarse weaving (such as 
horse reins), games of all kinds; collecting stamps; color- 
ing pictures by using water color paints or crayons; col- 
lecting stones, shells and all manner of things. 



CHAPTER XXI 



THE CAKE OF CHILDREN 

From the time of birth, an infant requires intelligent 
care in its helplessness, much as an invalid might. For 
although this is a natural process it is often accompanied 
by disorders, many of which are preventable by care and 
good judgment. 

Even if normal and healthy, children are frail and func- 
tional disorders spread from one organ to another easily. 
Whoever is in charge of little children must carefully 
observe their condition and any symptoms that are un- 
usual, such as the position a child takes, the sort of cry, 
the hand going to the eye, ear, or any part of the body, 
all of which may give a clew to what is causing the distress. 

SPECIAL CARE OF NEWLY BORN INFANTS 

The infant's eyes and mouth are washed with boracic 
solution or boiled water, and this repeated as often as 
necessary to keep them clean. Two to four drops of 20 
per cent. sol. argyrol are dropped into the eyes with a 
medicine dropper immediately after birth by the doctor, 
to prevent ophthalmia, and cold compresses are afterwards 
frequently applied. A dressing of dry sterile gauze and 
powder is placed around and over the ending of the um- 
bilical cord and held in place by a binder around the ab- 
domen, and it must be kept dry until the cord falls off, in 
about five days; after which pressure, by means of a pad 
over the part, is maintained in the same way for some 
weeks. 

Sweet oil or vaseline is rubbed over the skin including 
the head, and the infant is wrapped in a warm blanket 

186 



THE CARE OF CHILDREN 187 



and laid on the right side for some hours to free the heart 
from any pressure. Later, the position should be changed 
from side to side to promote active circulation in all parts. 
A sponge bath is given with warm water (100°) and 
castile soap at any convenient time during the first twenty- 
four hours. (Child should not be put into the water until 
the cord falls away.) The skin should be carefully dried 
and powdered and the infant dressed in simple clothing. 
For this will be needed a flannel band, 5 inches wide and 
1 yard long, to place around the abdomen (later on this is 
changed to a band with straps over the shoulders) ; a long- 
sleeved shirt of wool and silk mixture; diapers of cotton 
birdseye; a flannel and a muslin slip. 

The urine and feces at this time are very dark in color 
and will be until the contents of the intestines at the time 
of birth have passed off. 

Feeding. If a child is to be nursed by its mother, it 
is put to the breast 6 to 12 hours after birth and for the 
first few days about every four hours. The supply of 
milk is scant at first and acts more as an aid to clear the 
intestines than as a food until the third day, when the 
breasts become normally full. If there is any discharge 
from the eyes it is important to cover them before allowing 
the infant to nurse, to prevent infection being carried to 
the breast, and to wash the mouth before each feeding, and 
the nipples of the breasts before and after each feeding, 
with boracic solution. Have the nipples carefully dried. 

If the infant is to be fed otherwise for the first day give 
only sugar of milk and water, % oz. at a time, every three 
or four hours. Then gradually begin modified milk in the 
formula prescribed, starting with 1 oz. and slowly increas- 
ing the amount as the capacity of the stomach increases. 
This is given at regular intervals of three hours during 
the day and once or twice during the night. Boiled water 
given between feedings relieves thirst and aids normal 



188 PRACTICAL HOME NURSING 



functions and is very necessary, especially in warm 
weather. 

After the cord falls away a warm tub bath (100°) is 
given daily. (See page 190.) The skin around the groin 
and buttocks must always be kept clean, dry and well pow- 
dered with rice powder or stearate of zinc, and diapers 
changed frequently. There are two or three movements 
from the bowels daily and the child sleeps most of the time 
and needs good fresh air (not too cold) when sleeping; and 
the eyes must at all times be shielded from direct light 
falling on them and the infant kept quiet and the body 
temperature taken (usually recording from 99° to 100°). 

In raising the baby support its back and neck. Change 
position of infants frequently enough while the cranial 
bones are soft to allow proper molding of the skull. 

Keep the nostrils free from discharge by swabbing out 
with albolin on a little pledget of cotton. If stopped up, 
the child is restless and breathes with difficulty. 

GENERAL CARE OF SMALL CHILDREN 

Normal development in the child depends largely upon 
the freshness of the air it breathes, the nourishing quality 
of the food and its suitability to the individual needs and 
the climate; also upon cleanliness, the elimination of 
waste, sufficient sleep and not too much excitement (this 
reacts on the nervous system at that age). 

The average weight of an infant is about 7 pounds at 
birth and the usual gain is from 4 to 6 ozs. a week. 
Occasionally there are intervals with no gain and this 
should not be a cause of worry as the deficit may be made 
up within the next few weeks, but usually week by week 
and month by month there is a steady increase in weight. 
Muscular development is gradual and natural and in- 
creases as in adults from normal use of muscles. Cloth- 
ing should not restrict the natural movements of the body 
and the armholes should be made large. It is also to be 



THE CARE OF CHILDREN 



189 



remembered that strain on the muscles of little children by 
too long walks, too much exercise, too long intervals with- 
out sleep are harmful and react on the nervous system 
with the result of fretfulness, irritation, and unnatural 
conditions for a healthy child. Teething occurs at vari- 
ous ages, usually there are 

6 teeth during the first year. 
12 at 1/4 years. 
16 at 2 years. 
20 at 2% years. 

This completes the first set. While teething is a normal 
function, the child is often upset and fretful for a few 
days, particularly in the case of delicate children. The 
second and last set of teeth commences when the child is 
about seven years of age and, completed, numbers 32. It 
is most important that the first teeth be kept healthy by 
having them clean, attended to and filled if necessary to 
enable the permanent set to develop under healthy condi- 
tions. 

Nursery. Have a bright room for a nursery with dark 
and light shades. Keep it well ventilated and evenly 
heated at a temperature of from 65° to 70° during the 
daytime and from 50° to 60° at night. 

It is advisable to have everything in the room, such as 
walls, floors, furniture, rugs, etc., of such a nature that 
they can easily be kept clean. An enamel or brass crib 
is desirable, fitted with a woven wire spring and a hair 
mattress, or a folded blanket as a substitute, with a rubber 
or quilted protector. Soft, hair pillows (not full) are 
cooler than feather ones. Pillow cases and sheets should 
be of smooth texture ; the blankets and spread very light 
weight. In addition, all the necessary furniture, includ- 
ing a screen, should be provided. It is a great conveni- 
ence to have a table 30 inches high, 36 inches long, and 27 



190 PRACTICAL HOME NURSING 



inches wide with a board about 4 inches high forming a 
rail around the top. This rail prevents the child from 
slipping from the table when placed there to be bathed or 
dressed or to have its diapers changed. 

In an adjoining room there should be an ice-box and 
some apparatus for heating water. 

Bathing. A bath should not be given sooner than an 
hour and a half after eating, because by thus drawing the 
blood away from the stomach the digestion is interfered 
with. For little babies the temperature of the bath is 
100° ; this is gradually decreased to 90° as the age in- 
creases. The room should be warm during bathing time 
and without draughts. A baby's bath tub can be conveni- 
ently placed on a stool or a table, or the regular tub in the 
bathroom be used. A little baby may be dressed and un- 
dressed on your lap (in which case wear a flannel apron, 
useful to wrap around the child), or on the table above 
described, or even on the crib, but this is not as convenient 
a height. For larger children use either of the last two 
methods. Have everything ready : — blankets, towels, 
wash cloths, castile soap, cotton, powder, boracic solution 
and lubricant, and warm clothing arranged in order as 
needed. 

Before putting the child in the bath, wash the eyes, 
mouth, ears, nostrils and face (head, if required). Also, 
with a girl-baby, wash carefully with boracic solution the 
genitals, and with a boy press back the foreskin and wash 
over the surface, then draw it in place again. ( A deposit 
from the urine sometimes irritates these parts and causes 
distress, restless sleep and loss of appetite.) Then take 
the child on your left arm, and, holding the feet in the 
right hand, lower into the water and bathe. If a child 
has been frightened by the water at any time, overcome 
this feeling by wrapping a soft blanket or a turkish towel 
around the body before putting into the bath, so that it will 
feel the water gradually and get over its fright. 



THE CARE OF CHILDREN 



191 



It is considered a preventative to taking cold and a tonic 
to the skin to accustom the child to a cold sponge after a 
warm bath. When taken out of the bath, wrap the child 
in a blanket or towel, dry carefully, especially between 
every fold of the skin and powder surface where the mois- 
ture might collect. 

To dress, first put on the band, shirt, diaper (being care- 
ful not to draw in the knees with the diaper), stockings or 
booties. The skirt and slip may be put on together over 
the head, avoiding touching the face with them. 

The skin. At bathing time examine the skin care- 
fully and see if there is any undue redness, irritation or 
rash of any sort, particularly between the folds of the skin 
at the neck, back of the ear, in the groiu and around the 
buttocks. A child's skin is very sensitive and moisture 
and heat combined may cause irritation and a breaking 
down of the surface. Cleanliness and dryness are the 
essential points to be remembered in order to keep the 
skin healthy. This, of course, is aided by good nourish- 
ment and sufficient exercise. 

The mouth. Wash the mouth of the young child 
morning and evening with a swab of cotton twisted around 
the finger, and wet with sterile water or boracic solution 
(1 part to 3 parts of water). Wash the roof of the mouth 
without pressure from the finger and also swab around 
the sides of the gums. When teeth are developed, clean 
these carefully with cotton wound on a small wooden stick 
or toothpick, and have older children rinse the mouth after 
eating and use a soft toothbrush as soon as that is prac- 
tical, particularly at night and in the morning. 

Stools. While on a milk diet, an infant's stools will 
be yellow smooth, with no curds and average from one to 
two daily. A child can be trained to have at least one 
movement at a regular time each day even in infancy, by 



192 PRACTICAL HOME NURSING 



being held over the receptacle with the legs drawn slightly 
toward the body ; or suppositories of castile soap or gluten 
are useful in helping to form this habit which is a very 
important one for health's sake all through life. 

Clothing. Clothing should be light in weight with 
the undergarments sufficiently porous to allow for the easy 
absorption of perspiration, and have the warmth evenly 
distributed to all parts of the body, the abdomen being 
especially well covered. Too much or too heavy clothing 
causes excessive perspiration which is weakening. To 
avoid taking cold, make changes in the weight of the 
clothing gradually. 

Sleep. A little baby sleeps most of the time and as age 
increases is awake at longer intervals. At six months he 
should sleep through the night 12 hours and also about 4 
hours during the day ; at 1 year, about 3 hours during the 
day. This day period is shortened as the child grows 
older and until about six years of age at least, the habit of 
sleeping an hour or even a half hour a day is an aid toward 
the foundation of health by avoiding overtiredness. 

Feeding. The normal food for an infant is human 
milk and no other form of nourishment can quite compare 
with it. The proportion of the different food elements in 
human milk suits the needs and as the child grows this pro- 
portion changes imperceptibly to meet its requirements. 
An infant nurses from ten to twenty minutes and the mouth 
should be washed out first and also the nipples of the 
breast (which are also washed off afterwards) with boracic 
acid solution. Regularity is important and there are 
usually seven feedings allowed in the twenty-four hours 
at intervals in daytime of three hours. 

As a substitute for human milk some form of cow's 
milk is prepared and given at the same intervals. 



THE CARE OF CHILDREN 



193 



Composition 


of cow's milk 


Water 


. . 87 parts 


Sugar 


. . 5 parts 




. . 3.03 parts 


Fat 




Mineral Ash 


.07 parts 



Modified milk is cow's milk changed to resemble as far 
as possible the qualities of human milk. 

Comparative table 

of human milk 

Water 87 parts 

Sugar 6 parts 

Protein 2.02 parts 

Fat 4.05 parts 

Mineral Ash . . .03 parts 
(Acid reaction) (Alkaline reaction) 

Process of modifying milk. The milk is first diluted 
to reduce the curd which is tough and not easily dissolved 
(while that of human milk is flaky and soft). Diluting 
also reduces the mineral salts. 

Cream is added to increase the standard which was low- 
ered by the dilution (see note on Top Milk). 

Sugar of milk or some other form of sugar, such as 
maltose, is added to make up for the deficiency in cow's 
milk. 

Lime water is frequently added to neutralize the acidity. 

The water used in this feeding must always be boiled 
and cooled. Cereal, in such a form as barley water, is 
sometimes substituted for the boiled water, partly for its 
food value, but more especially, to aid in preventing large 
curds from forming. 

If necessary to make this food sterile it is pasteurized. 

The food is strengthened by increasing the amount of 
milk and decreasing the proportion of water. When the 
quantity is increased it is at the rate of about % to 1 oz. 
at each feeding. 

Top milk. This represents a higher percentage of fat 
than in the ordinary bottle of milk. Instead of diluting 
the milk and then adding cream to raise the standard 



194 PRACTICAL HOME NURSING 



again, top milk is used, in which the percentage of cream 
is larger to begin with. 

Method. Have an average bottle of milk which repre- 
sents 4 per cent, fat, stand four hours. Remove the upper 
16 ozs. with a cream dipper or syphon without disturbing 
the rest of the contents of the bottle. This represents 7 
per cent, cream, and from that take the amount required 
for the day's feedings. 

Top milk table. 

Upper 16 ozs. equal 7 per cent, of fat 
Upper 20 ozs. equal 6 per cent, of fat 
Upper 25 ozs. equal 5 per. cent, of fat 
The whole bottle shaken together represents 4 per 
cent. fa + 



Examples of formulas. 

Age: 2 weeks 
Top milk (from up- 
per 16 ozs.) .... 6 ozs. 
Lime water ....... 1 oz. 

Milk sugar ( 1 oz. ) 

Boiled water 13 ozs. 



20 ozs. 



Age: 4 weeks 
Top milk 8 ozs. 

Lime water 1 oz. 

Milk sugar (1 oz.) 

Boiled water 11 ozs. 

20 ozs. 



Milk sugar is not counted in the amount of the feeding 
as it dissolves into small space. 

Unless the doctor decides on the exact formula to use 
it is advisable to be governed by the directions in such 
books as Dr. Holt's " Care and Feeding of Infants," Dr. 
Kerley's " Talks with Young Mothers," or various books 
by other authorities on this subject. These give the aver- 
age formulas suitable for the different ages and sugges- 
tions for the feeding of older children. 



THE CARE OF CHILDREN 



195 



Method of preparing feedings for twenty-four 
hours. 

Protect all feeding utensils, bottles, nipples, and food 
from flies. 

Don't fail to wash the hands before preparing the food. 

All the utensils should be boiled and cooled before 
using. 

The articles needed are : — 

A dish pan (to boil utensils in). 
A pitcher. 

A pint measuring glass. 

The required number of bottles. 

Funnel for filling the same. 

Cream dipper (Chapin dipper). 

1-2 bottles of milk. (The best and freshest milk 

you can afford to buy. ) 
Boiled water or cereal water, cooled. 
Lime water (if necessary). 
Milk sugar (lactose). 
Sterile cotton stoppers (see page 54). 

Method. Add the milk to the water in which the 
sugar has been previously dissolved, and also lime water if 
used. Mix these together and place in each bottle the 
amount required for one feeding and cover with the stop- 
per. If necessary, this is then pasteurized (see page 
36). If not, the bottles are placed directly on the ice 
and left there until needed. An ice-box is obtainable in 
which the center part contains the ice and the bottles 
placed in separate divisions can touch it directly. Other- 
wise the bottles must be placed in a wire holder and this 
in the general ice-box, touching the ice. 

Heating the food. Shake the bottle to mix and place 
it in warm water deep enough to cover the milk m the 



196 PRACTICAL HOME NURSING 



bottle. When warm, remove the stopper and with the 
inside part of it wipe off the edge at the top of the bottle. 
Then test for heat by pouring a drop on the wrist or on a 
spoon from which it can be tasted. Adjust the nipple 
and when giving it to the child, see that the milk is always 
in the nipple by holding the bottle at a good angle, and 
remove before it is empty, otherwise air is drawn in, caus- 
ing distress. Also see that it is taken slowly, as drinking 
milk too quickly allows it to form too large curds in the 
stomach. 

Care of bottles. After each feeding, these should be 
immediately washed out in cold water then in soap suds 
and boiled before using again. 

Care of nipples. Boil these, when new, for two min- 
utes. After use, they should be washed out carefully in 
cold water and once a day turned inside out and washed 
with a brush ; then kept in a covered dish in sterile water 
or boracic solution till needed. Make two holes in each 
nipple with a red hot, fine cambric needle. At least three 
nipples should be ready for use. 

Water is given independently of food, between feed- 
ings. It is frequently necessary to substitute other foods 
temporarily for milk such as whey, barley water, Imperial 
Granum, white of egg, rice water, malted milk, etc., and 
the regular diet must be resumed gradually. 

Fruit juices are added to the child's diet at varying 
ages from the sixth month up, starting with two teaspoons- 
ful and increasing the amount to 2 ounces and more ; the 
same with beef juice particularly where the milk is pas- 
teurized, as some of its value has thus been destroyed. 
Cereals in various forms are also added to food. 

In sudden hot weather, dilute the food, whatever it 
is. At any sign of illness, dilute the food and make the 
return to normal food very gradual. 




Method of restraining the arms. 



THE CARE OF CHILDREN 197 



QUESTIONS 

Describe the special care a baby needs for the first few 

hours of its life. 
If not nursed by the mother what food will child have for 

first 24 hours ? 
What special care does the mouth need ? 
What is the danger to the child from sore eyes? — to the 

mother ? 

Mention points in care of a child for its comfort. 
How should a baby be lifted up ? 
What is the usual gain in weight? 

Describe a suitable nursery and convenient furnishings. 
Describe method of bathing a child. 
How prevent chafing of skin ? 
What is modified milk? 

Why should the position of child be changed frequently? 



CHAPTER XXII 



CAKE OF SICK CHILDREN 

Most of the qualities required in general nursing apply 
in the care of sick children and more — more patience 
and tenderness, more firmness, tact and good judgment 
and better control of the voice. 

When taking charge, if you are a stranger to the sick 
child, make your presence known gradually and try and 
gain his confidence quietly. Closely observe symptoms 
such as sore throat, rash, stools — condition and color, po- 
sition, character of sleep, and the cry, whether sharp, 
moaning or fretful. 

RESTRAINING A CHILD 

To restrain a child from touching a sore place, scratch- 
ing pimples or during the dressing of a wound or when 
giving medicines or treatment : 

Methods. 

1. Place a sheet folded diagonally under the child ex- 
tending from the shoulders down and lay the child's arms 
down straight on either side of its body and fold the sheet 
firmly around and pin it. (This can be made long enough 
to include legs if necessary.) 

2. Place mittens on the hands and fasten to the under- 
shirt sleeve with safety pins. Have tape attached to the 
finger end of these and tie the tape to the bed loosely 
which prevents the child from getting the hands to the 
face while perfectly able to move the arms comfortably. 
The same arrangement for the feet can be devised if 
needed. 

3. A softlv padded splint can be bandaged on the arm 

198 




Method of restraint. 



CARE OF SICK CHILDREN 



199 



from the hand to beyond the elbow point. This allows 
free movement of arm, yet the child is unable to reach the 
face. 

4. Restraint for an examination or treatment of 
the throat, nose, eyes, or ears. 

Method i. Restrain the child's arms as described; 
then place the child on your lap, facing the examiner, and 
place one of your arms across the child's body and the other 
hand against forehead to steady the head. *With a larger 
child use above method but instead of sitting on your lap 
the child must stand in front of you; then you can cross 
one of your knees over the other to hold the legs firmly. 

Method 2. Place the child in your lap, have him face 
the examiner, then put your right and left arms under the 
right and left arms of the child — by bringing up both 
your arms, you raise the child's arms and thus keep them 
out of the way of the examiner or operator. With both 
your hands on the child's forehead, you can raise or tilt 
the head while your knees crossed are securely keeping the 
child from struggling, and in that way you give the exam- 
iner a clear field for examination or treatment. 

General rules. 

When a child of any age becomes ill it is always wise : 

To take the temperature and examine the throat to 
find out if the trouble is there ; 

To give a warm bath which will relax the muscles, 
soothe the nerves and may bring out any latent rash 
under the skin ; 

To look for a rash on the skin ; 

To give a laxative or an enema ; and 

To dilute whatever food the child is taking by half. 
This food is easily increased and undigested food only 
complicates conditions. Isolate from other children until 
assured that there is no infection. 



200 PRACTICAL HOME NURSING 



FEVER 

Fever is not in itself a disease but is one of the symp- 
toms of some disorder and in a child this may arise from 
slight causes such as constipation, cold, indigestion; or it 
may be the initial symptom of serious illness depending 
on the degree of rise in temperature. 

Treatment. It is always safe to try and reduce the 
temperature by means of a sponge bath with alcohol and 
water, half and half, or by a tub bath at a temperature of 
85°. This will cool the skin, quiet the nerves and induce 
sleep. Also keep cold to the head, give an enema or laxa- 
tive, dilute the food and have the patient drink plenty of 
cool boiled water. 

VOMITING 

Vomiting may be a symptom of disease but usually is 
due to irritation of the stomach from various causes such 
as acidity in the stomach, food given at too short or ir- 
regular intervals, too much at a time or unsuitable in 
kind. Vomiting may also be caused by the effect of heat 
or of nerve strain. 

Treatment. If severe, cut off all food and give only 
boiled water with a little soda or lime water in it. Try 
to induce sleep to quiet the nerves of the stomach and 
when feedings are resumed, start with very small quanti- 
ties of white of egg or barley water or whey at regular 
intervals and keep the child quiet, lying down in a semi- 
darkened room. If a child shows a tendency to vomit 
after feedings, omit one feeding or give water in its place, 
make the intervals longer, give less in quantity, and keep 
the child quiet and in good fresh air. If this is not suc- 
cessful, the necessity of a change of food is indicated. 

RESTLESS SLEEP 

Prevent the child becoming overtired, provide fresh air, 
a cool and darkened room. See that the bowels are 



CARE OF SICK CHILDREN 



201 



acting normally, that there is no irritation on any mucous 
membrane nor irritation or chafing of the skin, that the 
nostrils are free and the breathing easy, also notice if the 
child breathes through the mouth and if so, raise the 
head a little for relief and call attention to this symptom, 
for this in itself makes restless sleep. Have the child 
comfortably warm but the bed clothes light in weight and 
not too plentiful. A warm foot bath just before bedtime 
is soothing and quieting. 

INCONTINENCE OF URINE 

If a child cannot control this function, an examination 
by a physician will be necessary, but if purely from a 
bad habit, it can usually be overcome by having the child 
avoid fluid at the evening meal and not drinking any after 
that and pass urine just before going to sleep. The bed- 
clothes should be fastened securely to prevent the child 
from feeling cold. A bath towel tied around the lower 
abdomen with a good knot over the lower part of the spine 
to keep child from sleeping on its back also helps overcome 
this habit 

VAGINITIS 

With vaginitis there is a catarrhal discharge from the 
vagina and in many cases this is of an infectious nature, 
especially to mucous membrane and other children must 
be guarded from danger of this infection. 

Treatment. The vagina is washed out with boracic or 
saline solution frequently and all cloths or utensils must 
be disinfected, and the diapers boiled and not even then 
used for other children. The general health of the child 
must be improved. Your own hands should be thoroughly 
disinfected after touching that part to avoid carrying in- 
fection to the mucous membrane of the child's mouth or 
eyes and for your own protection. 



202 PRACTICAL HOME NURSING 



PRICKLY HEAT 

Prickly heat is an irritation on the skin which rrakes 
any child fretful and restless. It comes as the result of 
heat, moisture on the skin or from too heavy clothing. 

Symptoms. The skin is covered with a rash of tine 
pimples that burn and itch. 

Treatment. Relief is best obtained from bathing the 
body frequently, either tub or sponge baths, using soda or 
bran instead of soap and water. Use plenty of water if 
giving a sponge bath and no rubbing, just pat the skin dry 
with a soft linen cloth and powder freely and often. 
Powder seems to relieve more than lubricants in this case. 
Use linen or silk next to the skin to prevent irritation from 
the underclothing and dress with the lightest of clothing. 
Prickly heat often causes digestive disturbance and there 
should be free action from the bowels. To maintain this, 
milk of magnesia is often added to the milk and plenty of 
water given to drink. 

OTHER IRRITATIONS OF THE SKIN 
Boils. A boil comes from some infection taken in 
through the skin which causes an inflammatory condition 
of the part. Until a physician sees it, keep a cold wet 
dressing of boracic solution or water over the boil and sup- 
port the part and keep it quiet. 
Hives. See page 138. 

Chafing of the skin. Use powder freely, which is 
usually enough treatment, but if the outer skin is broken 
or very much irritated, rub a little oxide of zinc ointment 
or cold cream and Pond's extract on the surface. For 
sore lips, camphor ice is soothing. 

INDIGESTION 
Indigestion may vary from a slight disorder to a seri- 
ous condition and is caused by the lack of proper digestion 
of food. This is shown in the stools, usually by the pres- 
ence of curds and often mucus. 



CARE OF SICK CHILDREN 



Treatment. The diet should be changed or the same 
type of food diluted and given in smaller quantities. In 
many cases this condition is overcome by a change of air, 
by an improvement in general living conditions, and by 
normal exercise, but in some cases, if patient is very much 
exhausted, rest is called for. 

COLIC 

Colic is usually a result of gas or air in the stomach or 
intestines, or it may be indirectly due to constipation or 
unsuitable food, or to cold. 

Symptoms. As the gas presses on sensitive parts and 
on nerves, the pain is very sharp and severe and the child 
instinctively draws up the legs towards the body as this 
position relaxes the muscles of the abdomen which are 
tense and hard. The child's cries are hard and strong 
and are repeated at intervals until relieved. 

Treatment. If the gas is in the stomach, put the child 
over your shoulder and pat the back. Give warm water 
with a little bi-carbonate of soda in it or peppermint. Lay 
the child, face downward, with the abdomen over a hot 
water bag for heat and pressure, which relieves the pain, 
or put the feet in hot water and mustard, lubricating the 
feet first to prevent the skin being irritated. If the colic 
is severe, an entire hot bath can be given which relaxes the 
muscles, allowing the gas to pass off more easily. An 
enema of soap suds with ten drops of turpentine added to 
it will usually give the quickest relief, or even inserting 
the rectal tube and leaving it in the rectum aids in ex- 
pelling the gas. Rubbing the abdomen also provides re- 
lief. 

DIARRHOEA 
Diarrhoea comes from an irritation to the muscles of the 
intestines and mav be caused by various conditions; as 
cold, indigestion, 'disease, etc. The stools are thm or 



204 PRACTICAL HOME NURSING 



watery, usually an unnatural color (green instead of yel- 
low) and too frequent. 

Treatment. Keep the child warm and in bed or at 
least quiet. Clear away the irritating cause by a dose of 
castor oil or some laxative. (Calomel is frequently or- 
dered in such cases to stimulate the liver to secrete more 
bile which is the natural fluid that clears the intentines.) 
Keep the abdomen and feet warm and prevent chafing of 
the buttocks. After the oil has taken effect, saline irriga- 
tions quiet the intestines and relieve thirst. For diet, 
give the class of food that is digested mainly in the stom- 
ach, such as condensed broth and barley water, white of 
egg and arrowroot gruel. When the condition is improved, 
increase the diet gradually. 

CONSTIPATION 

When there is a tendency to constipation, rub the abdo- 
men night and morning with warm olive oil — the direc- 
tion for rubbing is up the right side, across the top and 
down the left side — to stimulate the intestinal muscles. 
Establish regular habits to have a movement at the same 
time each day. If necessary, use suppositories of castile 
soap, gluten or glycerine or even an oil enema or one of 
soap suds to help overcome this difficulty, but these aids 
should be discontinued as soon as possible. The main 
point is to regulate the diet by giving an increase of fats, 
sugar, fruit juices (independently of food), green vegeta- 
bles — if the child is old enough to have them in the diet 
— the coarser grained cereals and breads. Milk of mag- 
nesia is often added to milk for its laxative effect. This 
gives no taste to the milk and is only for temporary use. 
Lime water, when included in milk formulas, has fre- 
quently to be temporarily discontinued as it tends to con- 
stipate. 



CARE OF SICK CHILDREN 



205 



SUMMER DIARRHCEA OR CHOLERA 
INFANTUM 

This may quickly become serious and needs the advice 
of a physician. The immediate distress is in the digestive 
tract and both stomach and intestines are involved. The 
indirect causes are usually heat, overfeeding, impure air, 
and it may be aggravated by teething. 

Symptoms. There is vomiting and diarrhoea, with 
stools green in color, watery and containing mucus, fever, 
loss in weight and appetite, thirst, restlessness, and ex- 
treme general weakness. 

Treatment. Give a dose of castor oil to clear away 
any irritating substance in the intestines and after the oil 
has caused a free movement, give a saline irrigation (see 
page 100). This relieves thirst through the absorption 
of fluid into the tissues and quiets the intestines as well as 
serving to wash away any foreign substance. Keep the 
child cool, quiet and in the open air, and if possible se- 
cure an entire change of air from the city to seashore or 
mountains. 

Use vaseline in the entrance to the rectum and over the 
buttocks as the acidity of the stools at this time irritates, 
and powder applied is not enough to prevent it. Also put 
a soft cloth to be worn inside the diaper. 

Remove milk from the diet for the time being and give 
barley or rice water, white of egg, and, when resuming 
milk, grade the amount carefully. 

THRUSH OR SPRUE 
Thrush is caused in most cases by uncleanliness of the 
mouth, and appears in white, flakey spots in the mouth. 
Sometimes every part is covered and again it appears only 
on the inside of the cheeks and gums. This distresses the 
child, making it difficult and painful to take food. The 
spots sometimes extend through the digestive tract to the 
rectum. 



206 PRACTICAL HOME NURSING 



Treatment. Wash out the mouth with boracic solution 
after each feeding aud swab over the surface inside the 
mouth several times a day with bicarbonate of soda or 
borax — one teaspoonf ul to half a glass of water ; avoid 
pressure as these spots must not be rubbed off. 

SORE THROAT 

If a child is hoarse or complains of a sore throat or has 
difficulty in swallowing, look into the throat and see if 
there is any sign of membrane there, if it is red and in- 
flamed or if it has white spots on it. It is never safe to 
take anything for granted about a sore throat and it should 
at once be reported to a physician. 

Treatment. For immediate relief, apply a hot, wet 
flannel to the outside of the throat or ice cold applications 
(ice bag or ice cold cloths), or a flannel soaked in cam- 
phorated oil. 

The throat can be sprayed with an astringent solution 
or, if the child is old enough, use a gargle of the same (see 
page 120). 

Give general treatment to reduce fever, a laxative or an 
enema, plenty of water to drink and a fluid diet. 

COLD IN THE HEAD OR CHEST 

For a slight cold in the head or chest, take the temper- 
ature, put the child to bed for a few days, or if around the 
house, guard from draughts, keep on a very light but 
nourishing diet with plenty of water. Give a warm bath 
and a laxative, and for local relief, wash out the eyes with 
boracic solution and swab the nostrils with albolin or vase- 
line to make breathing easier, rinse the mouth frequently 
and if the throat is inflamed use a simple gargle or spray 
and rub the outside of the throat and chest with camphor- 
ated oil or with this and turpentine mixed in equal parts. 

After any illness the important point is to build up the 
system with nourishing food, good air, plenty of sleep and 



CARE OF SICK CHILDREN 



207 



general care so that the resistant power will be increased 
and there will be less likelihood of a return of that or any 
other sort of illness. 

QUESTIONS 

Describe methods of restraining a child. 

What would you do for a child when it becomes ill? 

State the usual causes of vomiting. 

Give signs of indigestion. 

How would you reduce fever ? 

Give treatment for diarrhoea. 

What change in food can be made to overcome constipa- 
tion ? 

Mention means that could be taken to quiet a restless child. 
Mention points to observe about the condition of sick 
children. 



CHAPTER XXIII 

don'ts 

Don't fail to remember that tact, patience and self- 
sacrificing endurance are essential in the care of the sick. 

Don't tell the patient what medicine is being given. 
Leave that for the doctor. 

Don't discuss the patient's condition with the doctor in 
the presence of the patient if it is possible to avoid doing 
so. 

Don't remain in the room every minute of the doctor's 
visit. He may have something to discuss with the patient 
without you. This rule should also apply to visitors. 

Don't whisper in a sick room or just outside, in the 
hearing of the patient. 

Don't employ spare time in gazing at the patient, and 
do not rock in a rocking chair. 

Don't rattle a newspaper. 

Don't judge the temperature of a sick room by your 
own feelings. Use a thermometer. 

Don't make too many explanations to the family about 
things you need for treatment; don't frighten them un- 
necessarily. 

Don't knock against the bed in passing. 

Don't move or uncover a patient more than is necessary 

in giving a bath or any treatment. 

208 



DON'TS 209 

Don't fail to have things ready before beginning a 
treatment. 

Don't hurry your patient by seeming to be in a hurry 
yourself. 

Don't make larger washings than are necessary by care- 
less use of linen. 

Don't rub your eyes, or touch your face when dressing a 
wound, or after caring for the sick. 

Don't talk too much. 

Don't forget that it is an accepted fact that the mind 
has a great effect upon the body. 

Don't wake up the patient for food, medicine or treat- 
ment. 

But don't neglect to wake the patient for food, medicine 
or treatment if it is the doctor's order. 

Don't tell about former cases ; if asked, be discreet. 

Don't comment on the patient's appetite to the patient 
but observe this carefully. 

Don't forget that care in serving food attractively will 
often tempt the appetite. 

Don't fail to aid the doctor by obedience to his orders 
and by loyalty to him. 

Don't fail to be dignified. 

Don't take unnecessary steps or tread heavily in the 
sick room. 

Don't fail in kindness of heart, and in sympathetic un- 
derstanding of the needs of your patient. 

Don't fail to act calmly and wisely in an emergency. 

THE END 



GLOSSARY 



A 

Abdomen. Cavity between the chest and groin. It lies be- 
low the diaphragm and is the largest cavity in the body. 

Absorption. The sucking up of fluids or other substances by 
the tissues. 

Aesophagus. The canal extending from mouth to stomach. 
Albumin. A protein substance found in animal and many 

vegetable foods. It dissolves in cold water — coagulates or 

thickens by heat. 
Alimentary canal. The tube extending from the mouth to the 

anus — about 28 feet long. 
Antiseptic. An agent which prevents the growth of bacteria. 
Anus. The external opening of the rectum. 
Appendix. A small tube connected with the large intestine 

at a point on lower right hand side of abdominal cavity. 
Arteries. Vessels through which blood is distributed from 

the heart to all parts of the body. 
Astringent. An agent producing contraction of the tissues 

and thereby checking the secretions. 
Axilla. The cavity under the arm at its junction with the 

shoulder. 

B 

Bacteria. A form of plant life — germ — microbe. 
Bile. The secretion of the liver. 

Bladder. A sac that acts as a reservoir for urine with capacity 
of one pint. It forms front of pelvic cavity. 

Blood. The vital fluid of the body — circulating through heart 
and blood vessels. 

Bone. Tissue forming the skeleton of the body. 

Brachial. Relating to the arm 

Bronchial tubes. Air passage extending from the trachea into 
the lungs. 

211 



GLOSSARY 



C 

Capillaries. Small blood vessels connecting arteries and veins. 
Carbohydrates. Food substances which include sugars and 
starches. 

Carbon dioxide. Carbonic acid gas, an important constituent 
of exhaled air. 

Catarrh. Inflammation of mucous membrane accompanied by 
discharge. 

Cathartic. Medicine to cause a movement of the bowels. 
Cell. A minute part of a living substance. 
Chest. The cavity extending from throat to abdomen. 
Clavicle. Collar bone. 

Chyle. The milky fluid which is the result of intestinal diges- 
tion of food. 

Chyme. The fluid into which food is changed by stomach di- 
gestion. 
Colon. The large intestine. 

Congestion. An accumulation of blood in one part. 
Constipation. The retention of feces that normally should be 

expelled by muscles of tbe intestines. 
Convulsion (Spasm). Involuntary contraction of the muscles. 
Corpuscle. A small body or cell. 

Counter irritant. An agent used to irritate the surface and 
draw blood from the deeper parts. 

Crisis. The turning point of disease. A sudden change. 

Croup. Inflammation of the larynx and trachea causing diffi- 
cult breathing. 

Curds. Coagulated proteid of milk containing some fat. 

Cuticle. The outer or scarf skin. 

D 

Decomposition. The decay of a substance caused by bacteria. 
Deodorant. An agent that destroys odor — fresh air — chemi- 
cals. 

Diaphragm. The muscular wall separating the chest and abdom- 
inal cavities. 

Diarrhoea. Frequent and too fluid evacuations of the bowels. 
Digestion. The process of changing foods to prepare them for 

absorption into the tissues. 
Disinfectant. An agent that will kill germs. 
Dorsal. Pertaining to the back. 

Douche. A stream of fluid directed into a cavity or over a 
part. 



GLOSSARY 



213 



Duct. A tube through which secretions from a gland are con- 
veyed. 

E 

Emetic. An agent to produce vomiting. 
Enema. Fluid injected into the rectum. 
Eruption. A breaking out. 

Eustachian tube. The canal leading from the middle ear to the 
throat. 

Expectorate. To spit up mucus from the throat or lungs. 

F 

Faint. Loss of consciousness caused by too little blood in the 
brain. 

Fecal matter. Discharge from bowels mainly the residue of 

food that has not been absorbed. 
Femur. The thigh bone. 

Ferment. Is an agent that can break up a complex substance 

into simpler substances. 
Fibula. The smaller of the two bones of the leg. 
Flaxseed meal. Meal ground from seed of flax — used for 

poultices. 

Foreign body. Any substance that does not normally belong 

in the part where it is. 
Fomentation. An application of moist heat — cloths wrung out 

of hot fluid and applied over a part. 
Fracture. The breaking of a bone. 
Fumigation. Disinfecting by gas, vapor or heat. 
Function. Natural action or use of a part. 

G 

Gastric juice. The digestive fluid secreted by glands of the 
stomach. 

Genitals. Pertaining to generative organs. 

Glands. An organ whose function is to produce a secretion. 

Groin. Depression between abdomen and thigh. 

H 

Health. Normal condition — free from disease. 

Heart. A muscular organ situated in chest cavity which forces 

the blood into the arteries. 
Hemorrhage. An escape of blood from a blood vessel — Arterial 

— Venous — Capillary. 



214 



GLOSSARY 



Humerus. Bone of the upper arm. 

Humidity. Excessive moisture of the atmosphere. 

I 

Intestines. The alimentary canal extending from stomach to 
anus. 

Indigestion. Lack of normal digestive power. 
Infection. The communication of disease germs. 
Inhalation. Breathing in of vapor or fumes. 
Intermittent. Occurring at intervals. 

Incontinence. An involuntary evacuation of feces or urine. 
Insomnia. Sleeplessness. 

Isolate. To separate one from another — to keep apart in or- 
der to prevent spread of infection. 

Irrigation. A flow of fluid over a surface or wound or into a 
cavity. 

K 

Kidneys. Two organs lying in the hollow of the back on either 

side of the spine. They secrete urine from the blood. 
Kumyss. Fermented milk made with yeast. 

L 

Lactose. Sugar of milk — an easily digested form of sugar. 
Ligaments. Strong bands of fibrous tissue which hold bones 

together at joints. 
Liniment. A mixture of a drug and oil for external use. 
Lubricant. An oily substance that makes smooth when applied. 

M 

Massage. Scientific rubbing and exercising of the body to 
stimulate tissues and muscles. 

Muscles. Organs of motion composed of strong muscular tis- 
sue, capable of contracting or relaxing. 

Membrane. Thin tissue lining the cavities of the body and sur- 
rounding some organs. 

N 

Narcotic. Producing stupor. 
Nasal. Pertaining to the nose. 

Nausea. The sensation that makes one desire to vomit. 
Nerve. A fiber conveying impulses and sensations to and from 
the brain and spinal cord. 



GLOSSARY 



215 



Nitrogen. A gas or element of the air. 

Nozzle. A tip end — glass or rubber — with an opening. 

Nutrition. That which nourishes — food. 

O 

Ointment. Soft, greasy substance for external use. 
Ophthalmia. Inflammation of the eye. 

Organ. A part of the body which exercises special function. 
Ovum. An egg. 

Oxygen. The gaseous element that supports life and an im- 
portant constituent of inhaled fresh air. 

P 

Pancreas. A glandular organ secreting pancreatic juice; this 
is conveyed to the small intestines to assist in digestion of 
food. 

Paralysis. Loss of motion or sensation to any part. 
Patella. Kneecap; a round bone in front of the knee joint. 
Peptonized. Food partially digested by artificial means. 
Periosteum. The membrane surrounding bone. 
Peristaltic action. The peculiar wave-like contraction of muscles 

by which the contents of the stomach and intestines are 

moved on. 

Perspiration. Fluid secreted from the blood by the glands of 
the skin. 

Phlegm. Thick expectoration coughed up. 
Piles. Enlarged veins about the rectum. 
Pleura. The membrane covering the lungs. 

Poison. Anything taken into the system or developed in it 

that endangers life. 
Pores. Small openings on the surface — as on the skin. 
Poultice. Moist external application made of meal or any bland 

substance. 

Ptomaine poison. Poison usually produced from decomposition 

of food by bacteria in the alimentary canal. 
Pubes. The front part of the pelvis. 

Pulse. The beat felt in the arteries from the contraction of 
the heart. 

E 

Radius. Bone of lower arm on the thumb side. 
Rash. An eruption on the skin. 

Rectum. The lower portion of large intestine with function to 
expel feces. 



216 



GLOSSARY 



Residue. Waste from body tissues and what is left over of 

food after normal absorption. 
Respiration. The act of breathing which has two parts — in- 
haling and exhaling. 

S 

Skeleton. The framework of the body. 
Spinal. Relating to the spinal column. 
Spores. The seeds of some types of germs. 
Sprain. An injury to or stretching of a ligament. 
Sterile. Free from germs. 

Sterilize. To destroy bacteria on a surface or in a substance 

or fluid. 
Sternum. The breast bone. 

Stimulant. An agent that excites activity in the function of 

a part. 

Stomach. An enlarged portion of the alimentary canal lying 
between aesophagus and small intestines. It retains food 
during part of the process of digestion. 

Strain. An injury to or stretching of a muscle. 

Subclavian. Under the clavicle bone. 

Suppository. A cone shaped substance that will dissolve to be 
introduced into the rectum, etc. A drug is sometimes in- 
cluded in this substance. 

Synovial fluid. The fluid that lubricates a joint. 

T 

Temperature. The degree of heat according to some definite 
scale. 

Thermometer. An instrument to determine the heat according 
to a chosen scale. 

Tibia. The larger of the two bones of the leg. 

Tissue. A combination of cells with a special function. 

Trachea. The air passage from the throat to the lungs. 

Tuberculosis. A germ disease in which the affected tissue de- 
teriorates — wastes away. 

U 

Ulna. The bone of the lower arm on the inner side (little 

finger side). 
Umbilical. Relating to the navel. 
Urea. The chief solid part of urine. 



GLOSSARY 217 

Urine. Fluid secreted by the kidneys from the blood. A form 
of waste from the body. 

Uterus. Female generative organ situated in the pelvic cav- 
ity. 

V 

Vagina. The canal leading to uterus from the vulva (external 

female genitals). 
Veins. Vessels conveying blood on its return to the heart from 

all parts of the body. 
Ventilation. Changing the condition of air. Admitting pure 

and expelling impure air. 
Vertebrae. Bones of the spinal column. 



INDEX 



A 

Abdomen, 4, 107, 125 
Absorption, 21 
Acid, 120, 156 
Aesophagus, 4, 21, 25 
Air, 44 

in lungs, 12 

cushions, rings, 94 
Alcohol, as antiseptic, 57 

stimulant, 118, 141 
Alkali, 120 
Animal food, 24, 30 
Antiseptic, 52, 53 
Aorta, 10 
Apoplexy, 141 
Appendix, 4 
Appetite, 126 

to tempt, 27 
Appliances, 70, 72, 94 
Arteries, 10 

to control hemorrhage, 146 
Artificial respiration, 150 
Asepsis, 52 

B 

Bacteria, 49 

in wounds, 51 

in food, 27 
Bandages, 

ankle, 173 

arm, 169 

bellevue, 174 

clavicle, 175 

ear, 177 

eye, 177 

elbow, 168 

figure of eight, 165 

finger, 167 

foot, 171 

fourtailed, 162 

knee, 168 



Bandages, continued. 
leg, 171 

recurrent of the scalp, 178 
spica, 168 
spiral, 165 
spiral reverse, 166 
thigh, 172 
Baths, 79-86 

alcohol sponge, 84 
bran, 80 
children, 190 
foot, 85 
salt, 81 
soda, 80 
sponge, 83 
starch, 81 
tub, 82 

temperatures of, 80 
Barley water, 36, 193 
Beds, 63 

changing, 69 

making, 65, 66 
Bedding, 65 

changing, 67, 6S 

relieving weight of, 70 
Bedside notes, 128 
Bedpan, 92, 98 
Bedsores, 93 
Beverages, 35-38 
Bichloride solution, 57 
Bile, 23 

Bladder, 4, 18, 19 

Blood circulation, 9, 10, 127 

pressure, tests, 9 
Bones, 1, 3, 142 
Boracic acid, 57 
Brachial artery, 146 
Brain, 4, 7, 141 
Breath, 127 
Breathing, 6, 141, 157 
Bronchial tubes, 11 
Broth, 40 
Burns, 148. 151 



220 INDEX 

C Digest 



Calories, 27 
Capillaries, 10 
Capsules, 117 
Carbohydrates, 24 
Carbolic acid, 57 
Carbon dioxide, 44 
Catarrhal cold, 138, 206 
Cathartics, 119, 204 
Castor oil, 119 
Cavities, 4 
Cell, 1, 49 
Chest, 4 
Chill, 138 
Chyle, chyme, 25 
Children, 186 

bathing of, 190 

care of sick, 198 

common ailments, 200-207 

entertaining of, 184 
Coffee, 38, 99, 118 
Cold applications, 113 
Cold in head, 138, 206 
Clavicle, 3 

fracture of, 143 

bandage, 175 
Colic, 135 

infants, 203 
Constipation, 133, 204 
Convalescence, 181, 184 
Counter irritants, 1 ' 1 
Cranial cavity, 4 
Croup, 159 

Comfort of patient, 115 
Compress hot, 109 

cold, 114 
Convulsion, 158 

D 

Deodorant, 52 
Diaphragm, 4 
Diarrhoea, 134 

summer, 205 
Diet, 26 

convalescence, 33 

liquid, 33 

milk, 32 

soft, 33 

varying of, 27 



ion, 21 
juices, 22 
process, 23, 25 
Disinfectants, 52 
Dislocation, 144 
Don'ts, 208 
Disinfection, 
of clothing, 56 
discharges, 55 
hands, 56 
room, 57 
sputum, 55 
Dorsal position, 132 
Douche, 101 
Drowning, 151 

E 

Ear, earache, 136 

foreign body in, 153 

irrigation of, 102 
Electric shock, 151 
Emetics, 118, 156 
Enema, 96 

nutritive, 99 

oil, 99 

simple, 97 

stimulating, 99 
Entertainment of patient, 180 
Epileptic fit, 155 
Eruption, 126, 138 
Eustachian tube, 88, 103 
Eye, 

compress for, 104 
foreign body in, 153 
irrigation of, 104 

F 

Fainting, 141 
Fallopian tubes, 129 
Fats, 24, 25 

Fecal matter, feces, 29, 127 
Feeding, 

infant, 192 

helpless patient, 28 

Modified milk, 193 

preparing of, 195 
Feet, 89 

Femoral artery, 146 



INDEX 



221 



Femur, 3 

Fever, 16, 135, 200 
Fibula, 3 

Figure of eight, 165 
Fire, 149 

overcome by smoke, 150 
Flaxseed meal poultice, 110 
Fomentations, 107 
Food, 23 

care of, 27 

classification, 24 

digestion of, 23 

elements, 24 

serving of, 28 
Foot bath, 85 
Foreign bodies, 

ear, 153 

eye, 153 

nose, 153 

throat, 154 

swallowed, 154 
Formaldehyde, 57 
Fractures, 142 
Frost bite, 150 
Fumigation, 57 

G 

Gargle, 121 
Gastric juice, 22 
Generative organs, 4, 129 
Glands, 5, 7, 79 
Groin, 146 ■ 
Gruel, 39 

H 

Hair, 7 

care of, 87 

washing of, 86 

vermin in, 87 
Hands, 89 
Headache, 133 
Heat, dry, 106 

moist, 107 

exhaustion, 152 
Heart, 9, 141 
Hemorrhage, 145 

arteries for controlling, 146 
Hives, 138 



Hot water bag, 106 
Humerus, 3 
Humidity, 45 
Hysteria, 155 

I 

Ice, 30 
bag, 113 

caie of ice box, 29 
Incontinence, 10, 201 
Indigestion, 

acute, 152 

infant, 202 
Infant, 186 

bathing of, 190 

feeding of, 187 
Infection, 50 
Inhalation, 118, 141 
Insomnia, 137 

Intestines, 4, 22, 23, 1 19, 134 
Irrigations, 100-104 

ear, 102 

eye, 104 

nasal, 102 

rectal, 100 

throat, 103 
Iodine, 112 
Ipecac, 120 

J 

Jaw, dislocation, 144 

bandage, 162 
Joints, 5, 143 

K 

Knee bandage, 168 
Kumyss, 31 

L 

Lactose, 192 

Larynx, 11, 159 

Ligaments, 1, 5 

Lifting, methods of, 74, 75 

Lime water, 193 

Lime, 57 

Liniments, 113 



222 



INDEX 



Liver, 4, 21, 23 
Lungs, 4, 10, 11, 14 
Lymph, 10 
Lymphatics, 10 

M 

Massage, 90 
Mattress, 64 
air, 64 

changing of, 69 
Measures, 116 
Medicines, 116 
Membrane, 7 
Menstruation, 130 
Milk, 

altering conditions of, 31 

diet, 31 

formulas, 194 

infant feeding, 187, 192 

modified, 193 

pasteurized, 30, 36 

peptonized, 36 

sterilized, 31, 37 
Mineral food, 32 
Mouth, care of, 88, 186, 191, 205 
Moving, 

methods of, 74-78 
Muscles, 1, 5, 90 
Mucous, 7 
Mustard paste, 111 

N 

Narcotic poisoning, 157 

Nausea, 37 

Nerve strain, 8, 132 

Nervous system, 7-8 

Neuralgia, 137 

Nightgown, 

changing of, 70 
Nipples, care ff , 196 
Nitrogen, 44 
Nozzle, 101 
Nursery, 189 

O 

Occupations for convalescents, 
183, 184 



Ointment, 113 
Ophthalmia, 186 
Organs, 4 

Origin of the body, 1 
Ovaries, ovum, 129 
Oxygen, 7, 44 

P 

Pain, 124 

Pancreas, 4, 21, 23 
Paralysis, 8, 93 
Pastel la, 3 

Pasteurized milk, 30, 36 
Pelvis, 4 

Peptonized milk, 31, 36 
Perspiration, 7, 79, 81 
Peristaltic action, 5, 21 
Pillows, 64 

arranging, 71, 72 
Pleura, 11 
Poisoning, 156 

gas, 151 

irritant, 156 

narcotic, 157 

ptomaine, 157 
Pores, 7, 79 
Positions, 125, 132 
Poultices, 110 
Pulse, 12, 13, 14, 127 

R 

Radial artery, 13 
Radius, 3 

Rash, 126, 191, 198, 202 
Recipes, 35-43 
beef juice, 40 
beef tea, 40 
beverages, 35 

albumen water, 35 

cocoa, 38 

coffee, 38, 43 

lemonade, 35 

orangeade, 35 

tea, 37 

rice water, 35 
broths, 40 
coffee cream, 43 
eggs, 41-42 



INDEX 



$23 



Recipes, continued. 
gruels, 39 
jellies, 42 
milk, 

pasteurized, 36 
peptonized, 36 
punch, 37 
toast, 38 
whey, 37 
rennet or junket, 43 
rice, 39 
Rectum, 4, 15 
Respiration, 11, 12, 127 

artificial, 150 
Restraint, methods of, 199 
Retention of urine, 19 
Rubber, sheets, 65 
tubes, 96, 97 
bags, 106 

cushions, rings, 94 
Rubbing, 90 

S 

Saline solution, 56 

Saliva, 22 
Scald, 148 
Sepsis, 52 
Sheets, 65, 67 
Shock, 140 
Sickroom, 60 
care of, 62 
Skin, 7, 79, 126, 191 
Sleep, 124, 192, 200 
Sling, 163 

Soda bicarbonate, 120, ,.49 
Solutions, 57 

Spica bandage, 166, 168, 170 

Spinal canal, 4 

Spleen, 4 

Splints, 142 

Spores, 49 

Sprains, 143 

ankle, 144 
Sprue, 205 
Sterile, 52 
Sterilization, 52 

cotton, gauze, 54 

dressings, 54 

instruments, 54 

towels, 54 



Sternum, 3 

Stimulants, '.)'.), 117, 141 
Stomach, 4, 2i, 22, 25 
Stools, 191 
Strains, 144 
Structure ot body, 1-8 
Stupes, 107 

Subclavian artery, 146 
Sulphur, 58 
Sunburn, 149 
Sunstroke, 152 
Suppositories, 120 
Sweat, 81 

Symptoms, 123, 186, 198 
Synovial fluid, 5 

T 

Tablet, 117 
Tea, 37, 118 
Teeth, 88, 189 
Temperature, 

bath, 80 

body, 15 

reducing of, 16 

room, 46 

as symptom, 127 
Tendons, 5 

Thermometer, 15, 16, 61 
Thirst, 126 

Throat, sore, 139, 206 
foreign body Li, 154 
irrigation of, 103 

Thrush, 205 

Toast, 38 

Tongue, 88, 127 

Toothache, 136 

Trachea, 1 1 

Trav, 28 

Tube, rectal, 97 



U 

Ulna, 3 

Umbilical cord, 186 
Urea, 18 
Ureters, 18 
Urethra, 18 
Urine, 18, 19, 127 



224 



INDEX 



Utensils, 61 
Uterus, 129 



V 

Vagina, 129, 131 
Vaginitis, 201 
Vegetable food, 32 
Veins, 10 
Vena cava, 10 
Ventilation, 44, 46 



Vermin, 58 

in hair, 86 
Vertebrae, 2, 3 
Vomiting, 137 



W 

Waste, 12, 16, 25, 79 
Water, 24, 29 
Wasp bite, 154 
Wound treatment, 51 



PEINTED IN THE CNITBD 8TATES Or AMERICA 



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